The "Man Van": mobile PCa testing van being used in Alberta

Trolling the streets for customers...literally.

Unethical.

81 gy Guy,
Very interesting , thanks for posting that, bumping it up, brother.

Norm, We all know how you feel on this subject, and thats great. Thanks for your dedication to this foum and your education efforts. But for me, I would not define this effort as trolling or definitely NOT unethical. Like the commercial for older folks diapers...it all Depends on your outlook!
No more from me on that here.
Regards Wings, flying off now.

81GyGuy said...
(IMHO, positive outlooks expressed in threads here are usually much more productive than negative ones).

81GyGuy, IMHO, insightful posts which are rich in depth & understanding—whether they are the popular or bravely contrarian position—are the most productive and meaningful of all, and appreciated by most…

81GyGuy said...
It would seem a safe assumption that their staff considered and debated the pros and cons of the "Man Van" concept, and eventually came down on the "let's do it" side.

This is not a personal jab, but that’s a really naïve assumption. The “Centre” is part of a “full service” medical facility, Rockyview General Hospital and the Southern Alberta Institute of Urology. They were the first hospital in Canada to own and operate a daVinci robot; now they have several and they need to keep them busy ($$). Don’t want surgery? No problem; they also have a menu of radiation options to zap you with. After treatment, they also offer services to work on improving your erectile dysfunction. Full Service. It’s a business. Like every for-profit and not-for-profit, they have a marketing function whose job it is to generate prospects.

The “man van” is a marketing campaign of mass screenings to bring in prospects. It’s naïve when people don’t realize that they are being marketed to (although it is effective marketing). But it even more naïve for men at a prostate cancer forum not to know and understand that this is exactly the reason behind the landmark USPSTF decision giving a low grade (D) recommendation in 2012 (revised 2017)…to eliminate mass psa screenings in favor of an informed discussion/decision which we have today. There is not a professional medical society on earth today that supports the “man van” marketing tactic or mass screenings.

Want a little PC/marketing history? Of course you do. (I'll answer for you since you are reading but not responding to this thread.) The first “PC Awareness Day” was organized in 1990 by a pharmaceutical company to “celebrate” the release of the very first anti-androgen drug, fultimide, which was for late-stage PC cases. In a ploy of marketing genius, the pharmaceutical’s newly organized “Awareness Day” included promotion of the new PSA test because it would help to identify more patients and therefore maximize sales of the new drug (a.k.a. trolling for customers). This was, of course, roughly co-incident with Dr Patrick Walsh’s breakthrough “nerve-sparing” surgery technique which also helped to facilitate a "bloom" in the market and starting by the mid-90s “mass PSA screening” began aggressively pushing upstream to younger and younger patients, and finding more and more incidental varieties of PC.

By the 2000s, 80% of PC diagnosis were “organ confined,” yet there was absolutely no stigma attached to urologists rushing patients into life-altering aggressive treatment without regard to high-risk, intermediate-risk, or low-risk. In the early 2000s though, medical thought-leaders began speaking loudly in their professional societies against mass screenings and overtreatment. But appealing to the clinician’s to do the right thing (stop overtreating) was ineffective, and it took the landmark USPSTF action in 2012 to finally squash (nearly) the practice of sending junior hematologists out from local hospitals to troll for customers at mass screenings at the mall, at work, at the race track, at the Y…or in a van. That USPSTF decision is a piece of PC history that we should all understand.

Post Edited (NKinney) : 2/6/2018 2:28:18 PM (GMT-7)

NKinney -

Well, it certainly looks like you've done your homework on this one, and those of us who follow your posts are well aware of your concern (and a reasonable one at that) about overtreatment.

What struck me just after reading your post was that, in an odd sort of way, organized medicine's approach to dealing with PCa and the like was, in a way, like the light and the dark side of the force in Star Wars. (Yes, an odd comparison, but bear with me for a minute).

Because of my nature I tend to view medicine and doctors as forces of light, there to help us, noble in numerous ways, and there for our collective good. The good side of the force.

So maybe I am a bit naïve in my opinion of doctors, as I tend to believe that the considerable majority of them are there for our good, and they practice their craft with all good intentions, and not merely to pad their wallets. If I am naïve in that way, then so be it.

But I'm also wise enough to realize that some healers and their organizations can have a dark side, with profit as their motive, and little regard for what harm they may do in the process. Going over to the dark side.

Are the motives of the Prostate Cancer Centre in the above case suspect in their approach, and operation? I frankly don't know. The lover of light in me wants to believe that they do have good intentions, and largely do good, mobile vans and all.

OTOH, have you uncovered evidence that they are indeed driven by a darker side? Well perhaps you have, I just don't know.

But what it does do is it makes me sad, very sad, because I do know that, regardless of the motives of this particular agency in Alberta, the problem you describe is indeed out there, and dark, and being perpetrated by somebody somewhere.

It just makes me very sad.

NKinney, NKinney, why do you keep trolling for responses????

I declare, like the roller coaster at the height of its track, this thread is on the verge of taking a rather distinct nosedive in civility.

Personally, I would rather avoid that, but the next move, as they say, is yours.

The "brief, but spectacular" history of prostate cancer is very interesting, and filled with facts many people today know little about which have shaped the way things are today. For example, did you know...

Twenty-five years ago, it was mostly older men (the Medicare population) who where diagnosed with PC (not the typical low-risk diagnosis of today's era). You probably knew that; but here's where it starts getting interesting. After the introduction of the PSA test, the rate of radical prostatectomies nearly tripled between 1989 and 1992.

Then, in 1992, Medicare changed the fee structure for PC treatment services, and launched an investigation into RPs performed on high risk men over 75 (especially performed on comorbid men) because of the high attributable 30-day postsurgical death rate and high complication & re-hospitalization rates. This corresponds directly to the point where PC-reported deaths began to decline...there were lots of older, unhealthy (comorbid) guys dying on the operating tables in 1992.

As Medicare reimbursement rates started dropping in 1992 for the RP surgery (as a result of the fee structure changes; outcome of the investigation), the rate of the surgery among the medicare population dropped by 1/3 between 1992-1995 (the surgeons couldn't make as much money off them). Despite the medicare reimbursement drop, private insurance continued to pay high rates for RPs, and guess what...the rates of diagnosis and surgery among younger men covered by private insurance (provided by employers, for the younger guys still working) started rising (dramatically). The actual numbers of RPs performed continued to rise well into the 2000s with younger-and-younger populations of men with smaller-and-smaller amounts of PC (amounts which used to be left untouched by surgeons, with no consequence to the patients)...being fed by mass PSA screenings out of vans, at the malls, or other PC Awareness Day events!




The PSA test, and it's approval is another interesting story...

Post Edited (NKinney) : 2/7/2018 12:41:12 PM (GMT-7)

yeah, "man van" = unethical

McKinney, You ever driven across northern Alberta and Saskatchewan ? Some of those old farmers never go farther than the nearest town. And the towns are 100 miles apart in some places. It is not like trolling the streets of LA. They deserve decent health care and screening. I have known farmers that found cancer when it is to late. They don't treat it because They don't want to be a burden to their family. They just keep working till they die.