Two articles on screening controversies

I saw this one on MSNBC today:

www.msnbc.msn.com/id/35834880/ns/health-health_care/

And this on on the InfoLink from Forbes.com:

http://www.forbes.com/2010/03/11/prostate-cancer-health-care-opinions-contributors-marc-siegel.html

David,
While it's probably no connection, one could argue that why these controversies have gained so much legs in recent months is no coincidence to the health debate dominating our headlines. Insurance companies are profitable and they are fiscally responsible and can make money whether we test or not. The federal government is not profitable and no testing will save money even in just the programs that right now do cover these tests. I'd like to believe that the argument is a healthy phase to better treating future patients. But I am an optimist?

Andrew there are two separate arguments ~ over testing and over treating. But they argument against testing does not save lives, it saves money and in some cases side effects of an "overtreated" patient.

Tony

I wish the focus would shift. Just in orders of magnitude, if we spend tens-of-millions-of-dollars on testing, we spend hundreds-of-billions on treatment. Most PC does not need aggressive treatment. Energy discussing testing is being spent debating the wrong areas. Lets test everyone starting at age 25; but then lets treat only those that need treating.

In our current fee-for-service health care model, this won't happen. Doctors and hospitals are paid for how much care they provide, not the quality of the care, so one can easily understand how expensive treatments are growing increasingly popular & common. Not to get into a health care reform discussion, but his won't change until behaviors (and incentives) are changed.

My crystal ball sees more active surveillence & deferred treatment if and only if the tiny amounts of detected PC grow marketly worse despite patient lifestyle change efforts to avoid aggressive treatment.

My crystal ball also sees a tsunami of PC overtreatment controversy on the horizon (boosted by the upcoming Scholz book); and then the focus will shift from testing to treatment.

Purgatory said...
Tony, I don't like conspiracy theories in the least, but with the barage of stories like you posted, and others in recent months, one can't help but think we are getting set up by the insurance companies in the future for them to deny to pay for tests that people have been told for years to undertake. I thought pre-emptive care with medical matters was suppose to be smarter, and could be cheaper than dealing with things after the fact. Just don't like where this is going.

David in SC

You're all getting paranoid. The cost of testing PSA is not that expensive. The reason for most of these recent studies and articles is the resulting over treatment. The cost for radical treatments is not only financial but emotional too. I understand that many here will never admit that they may have well never needed radical PCA treatments but that is the truth. Once again I must state the obvious that it's about those with low risk numbers. If someone has a biopsy of 7+ and/or a family history they should keep getting tested. But numbers don't lie, if it saves only one life has never been a valid argument for me on anything be it lowering the interstate speed limits or saving that one life while lowering the quality of life for 48 other men. Education is what is needed here but if any article comes out wanting doctors to explain the problems with PSA testing to patients beforehand there are many here who jump to conspiracies and more.

Do you all think that because we have Pca that we know more or can question the motives of both doctors that developed PSA? That you all can question the veracity of any well known respected urologist just because you disagree with his recent thinking on PCa and testing? Do you think the New England Journal of Medicine is in cahoots with the powers that be to kill off men for some ulterior motive? If much of the thinking here could be transferred a few years ago to breast cancer, lumpectomies would now possibly be just a clinical trail and most women would still be receiving radical mastectomies.

Interesting that another post comes up about the controversy over PSA screening and over treatment. My SIL (I have 5 of them) called and asked me how John's diagnosis of PCa came about. Apparently, a family member of a friend was recently diagnosed, and Cathy (my SIL) was curious about all the recent attention to over treatment. She said to me "it looks like the trend for prostate cancer is to do nothing." Hmmmm...

John T...you hit the nail square on the head. I am reluctant to believe that any of the hype that has come out recently about over testing and over treating PCa has far more to do with politics than with health care.

Like others have said, I think all these new "guidelines" are setting us up for drastic changes in our healthcare.

Sephie said...
"... drastic changes in our healthcare."

Sephie, you have hit the nail on the head...we need change, and we need it soon before we drown under the unsustainable costs. 

Just to be clear, I'm building onto my earlier posting in this thread about treatments—not testing—because the cost of PSA testing is a drop in the bucket compared to unnecessary PC treatments.

It is crucial to reduce the unnecessary costs that are dragging down our health system's efficiency.  Unfortunately, we have preverse financial incentives which pay generously for high-cost services while underpaying for primary care, prevention and illness management.

I am glad to see & read about the growing energy and enthusiasm behind Active Surveillance/deferred treatment, primarily for the benefit to the patients who have tiny, microscopic amounts of PC but are far too often rushed into aggressive, expensive treatments (that often do more harm than good), but secondarily for the common sense approach to medical treatment that A.S. represents.

My crystal ball into the future foretells of more aggressive resistance to aggressive treatments.  Aggressively treat those that need treatment; don't aggressively treat those that don't need aggressive treatment.

Hi Tony,

Great post.  I read the articles with great interest.  Thank you.

Funny story: about one year ago, I was talking with a friend of mine about the increasing pressure on men to opt out of prostate cancer screening.  I joked with him that there would NEVER be pressure applied to women to opt out of breast cancer screening.   Well, in the autumn of last year we heard a barrage of reports on the news, encouraging women to do just that!  Here's just one link on a report from a government task force: http://www.msnbc.msn.com/id/33973665/

I do not believe this is a consipracy against men or women.   I believe this is a deliberate action to reduce the "burden" on the health care industry by some governmental and private health care officials.

I think the increased screening has really been a good thing.  People are taking charge of their own health care.  They want answers.  I know many men and women who clearly would have died long ago from various forms of cancer had they not been "aware" and proactive and sought screening and treatment. 

Try to tell these people that living long enough to see a child or grandchild born,  to see a child or spouse graduate from college, or to celebrate another birthday or anniversary with loved ones wasn't worth seeking out treatment.

My mother died recently and she appreciated every moment that she could see another sunrise and communicate with family.

It is true that some tests are not necessary and we know that medical science is not an exact science.  However, I see people like those on this forum asking good questions and trying to make informed decisions about their journey in this life.  What more could you ask? 

As long as we have choices, we should feel free to make them to the best of our ability in consultation with whomever we have chosen for a health care provider.  We should not allow others to make us feel guilty for making those choices, especially if the tests expose that we don't have a dreaded disease.  What a blessing!

You guys are great.

Thanks for "listening" to my rambling.

Barry

realziggy,

I admire your clear thinking, not to mention your patience and persistence.

Zen9