With a therapy that's not cheap, not easy, and not proven.

The front page of Friday's New York Times takes Americans to task for ignoring simple, proven ways of preventing cancer, leading with the blockbuster example of finasteride, a generic drug that, for a mere $2 a day, could prevent 50,000 prostate-cancer deaths a year. Wow, just $2 a day? And 50,000 lives saved? How could we be ignoring this? As one researcher quoted in the story, Dr. Ian M. Thompson of the University of Texas says, “A scientific discovery that is very clear cut and not implemented by the public is a tragedy.”

The scientific discovery that's involved here, though—and somehow the Times skips noting that Dr. Thompson is the principal investigator of the key study upon which the article relies—isn't nearly as clear-cut as the Times' Gina Kolata would have it. Look at it more closely, and the Times' proposal doesn't offer a bargain-priced magic bullet for prostate cancer but another chapter in the dreary story of how Americans drive health care costs ever upward in the pursuit of the latest medical hype.

Costs that the Times presents as trivial—a mere $2 a day—turn out to be not trivial at all when you look at the numbers in a different way. The study of finasteride—better known under its trade name as a hair-growth formula, Propecia—measured the effects of the drug on prostate cancer diagnosis in men 55 and over. There are about 29 million men ages 55 to 80 in the United States. Implementing the study's findings to get the drop in cancer deaths that the Times advertises means having each of them take the drug at a cost of $2 a day—that's $730 a year—or a total cost of $21 billion a year, a number that is by no means insignificant.

Still, even at $400,000 or so per life saved, finasteride might be a pretty good deal if the results were really that certain. But that's not the full story of the drug. The online version of the Times' article links to a summary of Dr. Thompson's prostate-cancer study, but the details of that study are more complicated than the New York Times lets on. In the original 2003 analysis, while the men taking finasteride did have close to 25 percent fewer prostate tumors, the number of serious tumors (measured by the Gleason scale, a standard way of evaluating prostate tumors) in that group was actually higher. It's for this reason that doctors approached those findings warily: It seemed from those results that finasteride might prevent less aggressive cancers that aren't deadly in the first place while potentially increasing the number of serious cancers.

A more recent analysis of biopsy results from men in that study, published in June 2008, concluded that this is probably not the case. Because finasteride shrinks the prostate, it makes diagnosing cancer easier, and the bottom line from the re-analysis is that finasteride does reduce prostate cancers by close to 30 percent. So a savings of 50,000 lives now—only after the 2008 re-analysis—looks more plausible. But it still involves an extrapolation from that data that is nowhere close to certain, since the study looked only at the rates of diagnosis, not the death rates.

This is still an important result, but it's far from Kolata's contention that the public has blithely chosen to ignore evidence of a devastating weapon against prostate cancer. The implication of the Times' story's argument is that a year after the publication of the re-analysis that shows strong evidence of a lowered prostate cancer risk, the United States should have turned on a dime and embarked on a $20-plus billion a year treatment program. This without regard to finasteride's negative side effects, such as those linked to sexual functioning, obviously a downer (and if you want to correct that, then start adding to the total cost).