On the menu today: Let’s do our best to avoid anything that could be construed as unduly speculative about former President Joe Biden’s health. (Notice that as usual, this newsletter is packed to the gills with links to direct sources.) The diagnosis of Biden’s cancer is a tragedy, and every American ought to pray for the best outcome possible. But instead of quieting the controversy about Biden’s health and the effects of aging in his final years in the White House, Sunday afternoon’s announcement of the diagnosis will justifiably intensify the questions about who knew what and when about Biden’s health. And while some commentators will accuse the Bidens of hatching a vast scheme to hide a presidential cancer diagnosis, I’d prefer to focus on one simple and extraordinarily consequential question: Why did Joe Biden as president not get the test that would have detected this cancer earlier?
The Missing Test
A prostate-specific antigen test, or PSA test, is a blood test used to screen for prostate cancer. As Johns Hopkins Medicine states, “It’s been the standard for prostate cancer screening for 30 years.”
While the general guidelines recommend starting at age 55, some men may need PSA screening between the ages of 40 and 54 if they have close relatives or multiple extended-family relatives who have been diagnosed with prostate cancer. It is recommended for men from age 55 to 69.
The years Joe Biden was vice president, when he was age 67 to 75, his doctor, Kevin O’Connor, did not release annual reports about his health. O’Connor remained Biden’s doctor when he left the vice presidency*. In December 2019, Biden’s presidential campaign released O’Connor’s three-page summary of the candidate’s medical history, which you can read here. (Don’t be misled by headlines like, “Biden Releases Medical Records,” which implies lab test results and specifics, not just a doctor’s selection of the information he believes is relevant.) There is no mention of a PSA test.
For four years during Biden’s presidency, O’Connor released an annual summary of Biden’s health condition. Each year, the report included an assessment of mild health issues, such as sleep apnea, seasonal allergies, and a stiffened gait — nothing that would likely interfere with presidential duties.
On February 28, 2024, O’Connor declared that Biden “continues to be fit for duty and fully executes all of his responsibilities without any exceptions or accommodations.” (Note that this was five months after Biden’s October 8, 2023, interview with special counsel Robert Hur, where the president did, in fact, sound like a “well-meaning, elderly man with a poor memory,” as Hur described, to furious howls of outrage among Democrats.) The report stated that Biden’s blood tests, including his comprehensive metabolic panel and complete blood count, were normal.
There was never any mention of a PSA test. Remember, PSA tests are blood tests, they’re not invasive, and Biden was already having blood drawn for other tests.
Lawrence Altman, a doctor who covered medical issues for the New York Times from 1969 to 2008, writes in STAT that there was never a good reason to give Biden a PSA test as president, and the current questions about why he didn’t get one represent “Monday morning quarterbacking”:
Based on the public record of Biden’s medical care and standard medical recommendations, as recently as a year ago there was no reason to perform screening tests for the disease, despite his age, 81 at the time. The diagnosis underscores the fact that cancers can sometimes pop up suddenly, even among recipients of the most sophisticated care doctors can offer. . . .
The test is controversial because it can lead to both false positive and false negative results. A false positive declares the presence of a condition when it is not, while a false negative says a condition is not present when it is.
For what it’s worth, Memorial Sloan Kettering Cancer Center has declared that the perception that PSA tests are not accurate is “a myth.” Dr. Andrew Vickers of Sloan Kettering explained, “What we want to know is whether PSA can predict who gets the sort of prostate cancer that can cause symptoms and threaten a patient’s life. It turns out that PSA is very good at doing that. . . . We know there are benefits, and that’s not controversial. . . . We have evidence that prostate cancer screening reduces the risk of dying from prostate cancer.”
It is surprising, to say the least, to learn that within 15 months, Biden went from a sparkling clean bill of health — “fit for duty” — to a stage 4 metastasized cancer diagnosis. (Research indicates “the median survival for patients with stage 4 prostate cancer is around 2 to 3 years. However, this can vary widely among individuals. . . . The five-year survival rate for patients with metastatic prostate cancer is approximately 30 percent.”)
One would like to think that the president’s annual physical would be thorough, even exhaustive — particularly for an octogenarian president who had survived two aneurysms, brain surgery, and the occasional trip over a sandbag or fall off a bicycle.
“I would assume that the former president gets a very thorough physical every year. One of the best screening tools that we have to detect cancer is called the PSA,” Dr. Chris George, Northwestern Health Network’s cancer program medical director, said to Reuters. “I would be interested to know what his PSA was the last time it was checked . . . it’s sort of hard for me to believe that he’s had a PSA within the past year, that was normal. It’s possible. It’s definitely possible, but that would surprise me. . . . Usually prostate cancer doesn’t, you know, go full throttle like this too often. When it does, that’s usually a bad, bad sign. That’s an aggressive cancer for sure. But it does seem odd to me.”
Based upon the publicly available information, Joe Biden never had a PSA test.
Monday morning, oncologist Dr. Ezekiel Emanuel shocked the hosts of MSNBC’s Morning Joe by declaring, “Oh, he’s had this for many years, maybe even a decade, growing there and spreading. That’s right. It’s a little surprising. I looked back at the records and there’s no evidence that when he got his health status and the medical records were released, that he had a prostate specific antigen.”
Ezekiel continued, “Now, it is true that a lot of people recommend not doing a prostate-specific antigen after 70, but President Biden’s been in public life a very long time. He was vice president and had a lot of exams under 70. So it’s a little surprising that they didn’t do it. And maybe President Biden decided he didn’t want the test. Many men do decide they don’t want the PSA, but this is also aggressive.”
Emanuel concluded it was “a little surprising to many of us oncologists that he wasn’t diagnosed earlier.” It will be rather difficult for the Biden team to dispute the qualifications or judgment of Emanuel; Biden himself appointed Emanuel to his Covid-19 Advisory Board.
On Sunday night, urologist Dr. David Shusterman told NewsNation Prime, “This is what I typically would see in a V.A. hospital, where a patient hasn’t had medical attention in ten years, presents to an emergency room with bone pain, and then they find it’s metastatic prostate cancer. But in the modern age of medicine, especially the fact that he’s a former president, he had intensive, state-of-the-art care where we can see prostate cancer. . . . The fact that we find it at a Gleason 9 is just pretty much unheard of in this day and age.”
Gleason scores range from six (low-grade cancer) to ten (high-grade cancer).
We are left with only three possible options:
- President Biden’s doctors did not think to conduct a prostate-specific antigen test, or did not believe that there was any need for one;
- Biden refused to agree to a test;
- or Biden did have a test, and those results were withheld from the public.
Yesterday, it was not hard to find those on social media who believed the president’s frequent weekends in Delaware were for secret treatments, or speculation about recurring marks on the president’s hands.
We knew that the people closest to Biden and those in his administration were lying about the president’s energy levels; perhaps most implausibly, on June 13, 2022, White House Press Secretary Karine Jean-Pierre said, “Oh, my gosh, he’s the President of the United States, you know, he — I can’t even keep up with him.” In February 2023, Delaware’s Democratic representative, and current senator, Lisa Blunt Rochester, contended Biden’s “energy is higher now than maybe when I first met him,” which was the late 1980s.
On January 5,the soon-to-depart president told USA Today’s Susan Page that his health was, “so far, so good.”
It is extremely likely that Joe Biden had serious and worsening prostate cancer in at least his final year in office, if not earlier. And as far as we can determine, his medical team — presumably amongst the very best doctors available in the country — never bothered to check with the one test that would have detected it, while giving him a battery of other tests.
To hear the Biden family tell it, in February 2024, Biden’s health was in exceptional shape for a man his age, and he was perfectly situated to serve as president until January 29, 2029. And then, like a bolt out of the blue, a deadly serious cancer diagnosis arrived just days before the publication of a book that detailed how Biden’s inner circle hid his condition from the American people.
Something here does not add up.
*In 2017, O’Connor discussed a business venture with the president’s brother James Biden, but the doctor never received any compensation and the health-care company, called Americore, filed for bankruptcy in 2019. You can read the passing references to Dr. O’Connor in James Biden’s testimony to the House Oversight Committee here.
Tests Are Good, and Also, Tests Are Bad
We are now in a circumstance where the Associated Press wants all its readers, particularly older men, to get themselves tested for prostate cancer:
When caught early, prostate cancer is highly survivable, but it is also the second-leading cause of cancer death in men. About one in eight men will be diagnosed over their lifetime with prostate cancer, according to the American Cancer Society.
And we’re also in a circumstance where, in the same article, the Associated Press wants to dispel the notion that Biden should have been getting PSA tests these past few years:
While the PSA test can help flag some cancers in some men, it does not do a great job of identifying aggressive prostate cancer, said Dr. Matthew Smith of Massachusetts General Brigham Cancer Center. . . .
Screening with PSA blood tests can lead to unnecessary treatment with side effects that affect quality of life. Guidelines recommend against PSA screening for men 70 and older.
The PSA test looks for high levels of a protein that may mean cancer but can also be caused by less serious prostate problems or even vigorous exercise.
For men aged 55 to 69 the U.S. Preventive Services Task Force says screening “offers a small potential benefit of reducing the chance of death from prostate cancer in some men.” The task force adds that “many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction.”
I suspect that within a few weeks, we will get additional panel discussions about why Americans don’t always trust medical experts and doctors.
ADDENDUM: You’re going to want to check out The Capitol Record from David L. Bahnsen — National Review Institute senior fellow and founder of The Bahnsen Group.
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