The march of progress has not been kind to comedy. The banana peel gag? Ruined when we developed a modern waste-management system. Seltzer in the face? Hard to accomplish with a can of La Croix. Crossed letters, missed phone calls, mixed-up messages left on answering machines? Driven to the brink of extinction by the cell phone.
And now the awkward rectal exam — comedy gold when matched with unsubtle gay panic and a gleeful, lubed-up, glove-snapping doctor — might become a thing of the past. Researchers at Wake Forest Baptist Medical Center just published a paper finding that the decidedly analog digital rectal exam (DRE) is a “clinical relic” that “subjects a large number of men to invasive, potentially uncomfortable examinations for relatively minimal gain.”
This comes as the latest salvo in the long-running argument over how concerned men should be about prostate cancer, and whether overdiagnosing it actually does more harm than the disease itself. Since the 1970s, doctors screening for prostate cancer have deployed the classic DRE in conjunction with a blood test for prostate-specific antigen (PSA), which can indicate cancer’s presence in the prostate at an earlier stage than even the most sensitive medical finger could detect by touch. The accepted wisdom was that men over 50 should get screened annually, using both methods, to catch cancer before it became deadly.
In 2012, the United States Preventive Service Task Force, a body of experts created by the Department of Health and Human Services to review the effectiveness of medical treatments, recommended against routine PSA testing, for the same reasons that Ablin had outlined two years earlier. But they didn’t say anything about the good old DRE.
Which is where this new study comes in. By looking at widely used long-term data sets on PSA and DRE screening effectiveness in Europe and North America, the Wake Forest researchers found that, by and large, the PSA test outperformed the DRE test in detecting cancers, but in 2 percent of the cases, the DRE found an abnormality where the PSA test had come back normal.
Within a different framework, in which prostate cancer was considered a roving killer and any advance in its detection could save lives, that 2 percent bump might be enough to justify a strong recommendation for national butt button investigation. But given that the powers that be recommend against the more effective screening method, the Wake Forest team concluded that a 2 percent bump wasn’t worth the countless man-hours of light anxiety, mild discomfort, and nervous jokes.
Unfortunately, like the callous banana sweepers, ignorant seltzer industrialists, and boneheaded inventors of cellular technology before them, the researchers behind this recommendation against digital rectal examination have failed to take into account the potential negative impact their work might have on America’s comedic economy.
If their suggested changes in treatment go into effect, the nation might soon face a future in which jokes about doctors sticking jellied fingers up men’s bottoms seem like absurd, pie-in-the-sky scenarios, rather than wry commentaries on the indignities of aging in the modern medical system. When writers wish to authentically portray their characters making googly eyes and sounds of discomfort in a quiet, brightly lit room, they’ll have to invent elaborate proctological backstories, or think of a non-anal premise altogether. Some will adapt to this new terrain, but others, surely, will be left behind.
At least we’ve still got banana cream pies.