The NY Times published an article today discussing the current Administration's approach to health care and in particular prostate cancer. It is a most telling article on how the new process of delivering health care will be approached. They discuss prostate cancer, one which we have spoken of many times in the past few months.
The article states:
"It’s become popular to pick your own personal litmus test for health care reform....
The article states:
"It’s become popular to pick your own personal litmus test for health care reform....
My litmus test is different. It’s the prostate cancer test.
The prostate cancer test will determine whether President Obama and Congress put together a bill that begins to fix the fundamental problem with our medical system: the combination of soaring costs and mediocre results. If they don’t, the medical system will remain deeply troubled, no matter what other improvements they make....
So let’s talk about prostate cancer. Right now, men with the most common form — slow-growing, early-stage prostate cancer — can choose from at least five different courses of treatment. The simplest is known as watchful waiting, which means doing nothing unless later tests show the cancer is worsening. More aggressive options include removing the prostate gland or receiving one of several forms of radiation. The latest treatment — proton radiation therapy — involves a proton accelerator that can be as big as a football field. ...
“No therapy has been shown superior to another,” an analysis by the RAND Corporation found. Dr. Michael Rawlins, the chairman of a British medical research institute, told me, “We’re not sure how good any of these treatments are.” When I asked Dr. Daniella Perlroth of Stanford University, who has studied the data, what she would recommend to a family member, she paused. Then she said, “Watchful waiting.”"
Now if a man suggested watchful waiting for breast cancer there would be hell to pay. First this is the wrong first issue. The first issue is to determine how aggressive the prostate cancer is and that is a cellular and genetic problem. You learn nothing from a Gleason score other than it most likely is not too bad or bad. Thus the works should focus on performing the research on assessing the nature of a specific prostate cancer and to develop procedure to monitor it in a cost effective manner.
Any physician who has dealt with patients with prostate cancer know that there are men who just will never die of it no matter how long they live and there are men who just seem to fall apart and die in months, each from the same starting point. So watchful waiting from a woman physician may be what we are in for in the future. Perhaps it is some Freudian form of revenge...
The same would be the case, as we have argued, for comparative clinical effectiveness studies. In a CCE study we may be measuring the effects of the different forms of cancer sells and NOT the impact of the treatments. Yet we have never determined the underlying forms of cancer cells. Performing a CCE study we see the results of different procedures on patients and we determine that watchful waiting is best, for example. The fact is that say 80% of the patients this is true and the 20% which die a painful death it was false because they had a different disease.
We now know much of the underlying genetics of breast cancer and we can now stage patients accordingly. We know different treatments work for different subgroups of breast cancer and we treat them accordingly. We must do the same for men as we do for women, not just let them die because some woman says so! Especially if that person is a Government Czar of some sort.
So let’s talk about prostate cancer. Right now, men with the most common form — slow-growing, early-stage prostate cancer — can choose from at least five different courses of treatment. The simplest is known as watchful waiting, which means doing nothing unless later tests show the cancer is worsening. More aggressive options include removing the prostate gland or receiving one of several forms of radiation. The latest treatment — proton radiation therapy — involves a proton accelerator that can be as big as a football field. ...
“No therapy has been shown superior to another,” an analysis by the RAND Corporation found. Dr. Michael Rawlins, the chairman of a British medical research institute, told me, “We’re not sure how good any of these treatments are.” When I asked Dr. Daniella Perlroth of Stanford University, who has studied the data, what she would recommend to a family member, she paused. Then she said, “Watchful waiting.”"
Now if a man suggested watchful waiting for breast cancer there would be hell to pay. First this is the wrong first issue. The first issue is to determine how aggressive the prostate cancer is and that is a cellular and genetic problem. You learn nothing from a Gleason score other than it most likely is not too bad or bad. Thus the works should focus on performing the research on assessing the nature of a specific prostate cancer and to develop procedure to monitor it in a cost effective manner.
Any physician who has dealt with patients with prostate cancer know that there are men who just will never die of it no matter how long they live and there are men who just seem to fall apart and die in months, each from the same starting point. So watchful waiting from a woman physician may be what we are in for in the future. Perhaps it is some Freudian form of revenge...
The same would be the case, as we have argued, for comparative clinical effectiveness studies. In a CCE study we may be measuring the effects of the different forms of cancer sells and NOT the impact of the treatments. Yet we have never determined the underlying forms of cancer cells. Performing a CCE study we see the results of different procedures on patients and we determine that watchful waiting is best, for example. The fact is that say 80% of the patients this is true and the 20% which die a painful death it was false because they had a different disease.
We now know much of the underlying genetics of breast cancer and we can now stage patients accordingly. We know different treatments work for different subgroups of breast cancer and we treat them accordingly. We must do the same for men as we do for women, not just let them die because some woman says so! Especially if that person is a Government Czar of some sort.
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