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Updated: Dec 9, 2025

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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Is one narrative enough? Analytical tools should match the problems they address.

Nathan Hodson1, Susan Bewley2

  • 1Department of Health Policy and Management, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA n.hodson@doctors.org.uk.

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|September 9, 2020
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Prostate Specific Antigen (PSA) screening for men does not demonstrably save lives and can lead to harm. Relying solely on personal stories for medical policy is insufficient and potentially dangerous.

Keywords:
philosophical ethicsprimary carepublic health ethics

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Area of Science:

  • Medical Ethics
  • Public Health Policy
  • Statistical Analysis

Background:

  • Prostate Specific Antigen (PSA) screening is promoted for early prostate cancer detection.
  • Narrative ethics, based on personal experience, is sometimes used to support screening policies.
  • Statistical evidence is crucial for evaluating the efficacy and harms of medical interventions.

Purpose of the Study:

  • To critically evaluate the evidence supporting Prostate Specific Antigen (PSA) screening for asymptomatic men.
  • To analyze the limitations of narrative ethics in appraising health policies.
  • To advocate for the use of robust statistical evidence over anecdotal accounts in medical decision-making.

Main Methods:

  • Review of Cochrane meta-analyses on PSA screening efficacy.
  • Analysis of the statistical evidence regarding false positive rates and overinvestigation.
  • Critique of narrative ethics using principles of counterfactual analysis and consideration of hidden harms.

Main Results:

  • Reliable meta-analyses do not confirm that PSA screening saves lives overall.
  • High false positive rates lead to overinvestigation, causing anxiety, sepsis, and dysfunction.
  • Narrative ethics alone is an insufficient and potentially biased tool for policy appraisal, overlooking harms.

Conclusions:

  • Prostate Specific Antigen (PSA) screening is an inappropriate tool for reducing prostate cancer mortality.
  • Narrative ethics is inadequate for evaluating health policies with significant hidden harms.
  • Accurate statistical analysis is vital for sound medical and ethical policy decisions.