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I think I got this whole "OD" thing figured out

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Posted 8/21/2013 3:36 PM (GMT 0)
Of course I don't have all of the answers, wish I did.  But, while unloading the dishwasher a little while ago, I had an epiphany of sorts about OD.

This concerns the existence, if there truly is, about OD (Over Diagnosis), which more than one person here questions, including myself.  Will state for the 500th time, OT is acknowledged, but that is not the subject on this thread.

So follow my logic:

According still, to the ACS, 1 out of 6 men will be diagnosed with PC in their lifetime.

That is high, considering that millions of men refuse to see doctors, have screenings, or take care of their personal health issues, unless they end up in an ambulance on  the way to the ER.

We also know, that whether one is screened or not, the real number of men with PC in their body is way higher than 1 out of 6, in fact, the more the man ages, the more likely he will have some PC in their body.

So, if you cut back on screenings (both PSA and DRE), and discouraging men from doing so, what do you get out of it, and who does it benefit?

What do you get out of it?

You get way less men diagnosed with PC, not a doubt about that, you could even reduce that 1 out of 6 real easy over time.

You will get men ultimately diagnosed (since they weren't screened early) with advanced disease.

You will ultimately increase the death rate because of the number of advanced cases, some of this increase might be off-set by new advances in Prostate Cancer treatments (hopefully)

Who does it benefit:

Well, it doesn't benefit urologists or uro/surgeons - no doubt, they make millions off of biopsies, screenings, and expensive operations if their patient chooses surgery

Well, it doesn't benefit radiation oncologists - they make the largest amount of my proportionally off of expensive radiation treatments.

So, why would doctors in general want to curb OD, if it exists?  It would be taking money out of their pockets, literally.

So who benefits?

It comes down to the health insurance providers and their lobbyists.  It has to be this.  They stand to gain the most by putting out this whole notion of OD.  It makes sense.  Our modern age of screening has been a disaster for the insurance industry.  More and more men are being diagnosed because of screening.  And these men are being treated, and like all industry, its killing their bottom line.

What could be more clever than to start pushing this idea, as if it were some noble or intellectual position to grab hold of?  And it's not a stretch, with their huge budgets, that the lobbyists for the health insurance industries to even infiltrate PC support groups, nationwide, and get their leaders and eventually members to buy into this notion.

This isn't a conspiracy theory, this is just plain good business sense.

By trying to tie OD to OT, it makes it look more noble, but it's just another self-serving tool to save billions of dollars a year perhaps.  One thing that I walk away with from working for 42 years, and most of that in finance and financial reporting, its always, and I mean always, about the bottom line.

I feel that even our dedicated advocates should be extra careful about letting the wolf into the fold, or the fox into the hen house.  The love of money, truly is the root of evil.

david in sc

I am prepared for all and any opinions on this thread.  I don't have all the answers.  I am not an expert.

 

Posted 8/21/2013 3:44 PM (GMT 0)
Yup, that's it!  They are after us.

wow!

Posted 8/21/2013 3:45 PM (GMT 0)
I've been saying this since day one.
Posted 8/21/2013 3:47 PM (GMT 0)
Could be, David, but I don't doubt there are also those whose only agenda is to try to minimize the damage done by unnecessary treatment. And to whom I say, get off the anti-OD train until you've done everything you can to address the OT issue first. Information can only do damage if we let it.
Posted 8/21/2013 3:48 PM (GMT 0)
My insurance has paid out nearly $100,000.00 since my first uro visit. They think I should have never been tested to begin with.
Posted 8/21/2013 4:05 PM (GMT 0)
David,

I think there's no single explanation.  What you have said may have some justification, but I can also easily understand why some men choose to focus on overtreatment.  No one wants to see anyone subjected to a complex and dangerous medical procedure unnecessarily.  I would hope we all share that concern.

However, with 30K men still dying annually from prostate cancer, I often find myself wishing that more focus would be directed at "undertreating"  (failing to identify those whose lives are truly threatened by this disease) than on "over-treatment." 

BTW, I've more than once seen comments from those who favor less screening and less treatment to the effect that we simply cannot sustain the level of medical expenditure that is currently happening, so, yes, I do think concern over the "bottom line" factors in to some degree.

We'll never see consensus on the best way to tackle these problems.  Some will focus in one direction, others will choose a different focus, but, happily, I don't see anyone here who lacks a sincere desire to find improved diagnostics, reduce unnecessary treatments, and offer better outcomes with fewer side effects for men whose lives are being affected by prostate cancer. 

 

Posted 8/21/2013 4:16 PM (GMT 0)
Personally I think every man should be tested at the age of 40 just as a baseline.....it just seems like good common sense to me. The idea is preventative medicine...catching the problem before it becomes a major problem. If I was tested at 40...I probably would have a good chance at a cure....instead I tested at 50 with symptoms and was already advanced. As the cancer grows so slow....theres no doubt in my mind my PSA would have been high at 40, or at least 45. Unfortunately like myself....most men never heard of a PSA number until being diagnosed.

In the long run....identifying this disease early will save the insurance companies money.....as you wouldn't have to treat for years with several different treatments already in the advanced phase. Im not even sure why this seems to be any kind of an argument here.......common sense folks.

Do they have an issue with overtreatment...sure....but the answer is not renaming it or stop screening....the answer is teaching patients all the options and holding the doctors accountable for over treatment. Because as you say david....this is capitalism.....its all about making money.

I'm not the smartest guy in the world but this stuffs not rocket science.

Posted 8/21/2013 5:32 PM (GMT 0)
thanks for some good civil replies, with the exception of one.

casey - to you, since you were the exception, I made it clear that I don't see what I am saying as a pre-meditated conspiracy theory. but what I am saying makes perfect sense. I have been assisting legally a very large and complex lawsuit for over 5 years now. It's where a small Money Service Business (MSB) was literally put into Chapter 7 because of the direct actions of one of the 10 largest banks in the country. And boy, have I learned a lot, about how far a wealth entity will go to, to avoid settling what is really a cut and dry case. At one of the last court hearing I was in with this case, the judge was very smart, and despite commenting on how there were over 50,000 pages of related documents, she was going to cut to the chase, and her words, "I am going to follow the money trail, and there will be the answer".

Same applies here with OD. All I am suggesting is following the money trail. Find out who benefits the most, and it keeps pointing back to the health insurance firms, they stand the most to win, if they can change the standard of care with this supposed OD. And by tying OD to OT (and I will never accept this tie, its just too convenient for the other side, the money side), it makes their job easier.

I still see some downplaying of the deaths from PC with those that are advocating major changes against the patient. Even if you rounded it off to just 35,000 deaths per year, and that's too low, that still means over 700,000 men have died in the past 20 years alone, and that's just here in the good old US of A.

Anything that kills 700,000 plus men is hardly a friendly cancer, or a benign cancer.

Instead of giving me a smarty pants sarcastic answer, see if you can break apart my theory based on facts. I am open to any well thought out reply or suggestion, as I already said, I don't have the answers and I don't have any inside knowledge. I am simply looking at OD from a business perspective, and I have a feeling, I am not too far off base.

Casper - I agree with you. I would like to see every man base lined at 40, perhaps even 35 if one was African-American and/or have family history of PC. It wouldn't hurt anyone. For many of these, it might not be needed to test every year after that, depending on the circumstances. I agree to, and will say again, this re-naming scheme is nothing but a parlor trick to me, doesn't fool anyone, and could put men at risk. And I think a person would have to be naieve if they didn't believe, like most things in life, that money wasn't the ultimate root cause of this "new thinking". You are right, it's not rocket science.

Casey has mentioned several times, about we are doing all of this for the next man in line, not for we who have been diagnosed and treated, if that were true, why would anyone want to discourage or endanger the next man in line, by deceiving him with this re-naming business, or denying or discouraging him from been screened and/or tested?

I stand by what I said at the end of one of my interviews from 2 plus years ago. I closed it by saying,
"They say that what you don't know won't hurt you, but with prostate cancer, what you don't know, can kill you".

david
Posted 8/21/2013 5:38 PM (GMT 0)
We think alike Purg! Well stated.
Posted 8/21/2013 5:44 PM (GMT 0)
Thank you, Bro. James, I am trying. And I don't think we are alone. Sometimes the simplest solution ends up being the correct solution. Why make something simple hard, unless there is another motivation at work?

David
Posted 8/21/2013 7:26 PM (GMT 0)
As a member of the 1% of men with PSA <4 yet bone mets at initial diagnosis and G9 (4+5), the AS the past few years literally saved my life with early detection.

However to your question David, the only benefit aside from the insurance companies you already mentioned would be if there were a shortage of Urologists such that those with advanced PCa could not be seen because so much time was being wasted on those without advanced PCa.

While that may be one of the future unintended consequences of ObamaCare at the moment it is a non issue.

As you allude it is not the Over Diagnosis, but rather the Over Treatment that is the real issue.

Even if the so called low grade cancer or newly named non cancers did not necesarily require treatment, having the prostate removed surgically or radiated and assoicated sense of well being does have some psychological benefit.

So I do not agree at all with the new guidelines.

LupronJim
Posted 8/21/2013 8:26 PM (GMT 0)
Purg you had me until your conclusion.

You do understand that advanced disease can be far more expensive to treat than local disease? The carriers should be on board with anything to prevent those costs associated with advanced therapies. You can treat 20-40 men locally for the price of one man on Provenge, then Xtandi, then Zytiga, then Taxotere, after HT, scanning many times, various salvage therapies...etc.

I have heard carriers approving PBT at 100k per round because they'd rather gamble that this patient won't be back later.

I think the conspiracy theorists might find an opportunity to blame everyone for changes in protocols. But this scene you have painted here it not logical and not really economical.

But to give your thoughts some merit, I am certain that the P&L of prostate cancer is a huge number that can be improved upon. I'm sure the insurance companies have had the bean counters on it. But when I see insurance companies resisting coverage it has almost always been with advanced treatments and much less so for the local ones.

Tony
Posted 8/21/2013 9:06 PM (GMT 0)
Oncologists would profit, David.

And sure, follow the money, always.
Posted 8/21/2013 9:13 PM (GMT 0)
the only people who think they were overtreated believe they no longer have cancer so they have either been "cured" or never really had cancer. imo, some people quickly forget where they came from and get back to complaining and blaming others for such things as ED and loss of ejaculate even though in the beginning either condition was acceptable as long as they didn't die.
to be fair, very few guys on this forum believe they were overtreated. (Comments deleted by Tudpock18

ed

Ed, please don't disparage other members. Thanks, jim

Post Edited By Moderator (Tudpock18) : 8/21/2013 3:19:36 PM (GMT-6)

Posted 8/21/2013 9:20 PM (GMT 0)
davidg said:
"Oncologists would profit, David."

Yup. And hospitals, and insurance companies, drug companies, clinics...etc. No matter which way the screening pendulum swings.

It is not wrong that this is a business. For insurance companies saving money is about as reasonable as raising rates to cover as much expenses as they encounter. Can they save money by pushing for a drop in screening. Yes. But they can make even more money by screening more men too. All they have to do to cover costs is raise premiums.

We already know that is true. The more expenses they have, the higher the premiums, the bigger the profits. It would seem that reducing screening for the carriers could actually be bad business.

Tony
Posted 8/21/2013 9:29 PM (GMT 0)
you cannot keep raising premiums, Tony, there is a limit to that. But you can certainly stop covering stuff. There is no limit to that.
Posted 8/21/2013 9:33 PM (GMT 0)
Purg
I think that closing line should be your closing line at the football halftime thing you are doing. That should get there attention.
RickyD
Posted 8/21/2013 9:39 PM (GMT 0)
Hmmm.
You can raise deductibles. You can raise co-pays. You can raise Rx rates. And I've had increases in the past to our insurance costs. The only thing you cannot do is tell a private insurer that they cannot cover their expenses in their rates. While regulated you can always adjust to the current needs through justifications.

Rising healthcare costs and affordable rates is what the ACA is all about. When healthcare costs go up rates go up with them.

Tony
Posted 8/21/2013 9:46 PM (GMT 0)
there is a limit to rising rates and what is sustainable. There is no limit to cutting back coverage.
Posted 8/21/2013 10:44 PM (GMT 0)

TC-LasVegas said...
Hmmm.

Rising healthcare costs and affordable rates is what the ACA is all about. When healthcare costs go up rates go up with them.

Tony

I think we will logically see some curtailment of services under ACA. It has to happen. More patients into the system with the same, or fewer, docs and something will give.

You may get your wish of cutbacks in over-treatment, simply through supply and demand.

No, I do not wear a tin foil hat to work. Those of us in health care are holding our collective breath waiting for the full glory of that which is officially known as ACA. We have other nicknames for it, but the filters here on the forum would render them unintelligible. smilewinkgrin
Posted 8/21/2013 10:53 PM (GMT 0)
Doug,
I hear ya on that. But this forum has to walk down the ACA discussion like we're on egg shells. It is a highly political discussion. But it will be more discussed in the future. For right now we don't have ACA in place.

I think it is possible that when rates are made more affordable they will have lots of extra costs associated with them. I've seen some of the state plans and the deductibles are huge in the ones I've seen. For now my own insurance is pretty good. We have never been denied a therapy and I've had a few expensive ones. My out of pocket expenses have not been anywhere near what the payout from my insurer has been. So the only place they will make it up is in the premiums that others pay. But I am thoroughly convinced they won't lose money on me...

Tony
Posted 8/21/2013 11:04 PM (GMT 0)
Sephie,
You posted at the same time I did and for the most part we were channeling our thoughts.

I'm not sure how insurers will handle the ODOT moving forward but I do have a fear that if we don't base screening on science then we will have issues moving forward. The USPSTF recommendation to end all PCa screening in America will continue to reverberate unless we can get them a better plan they can buy into.

Interestingly, if the USPSTF gets their way I don't think that ends screening for one minute. In fact I would see hospitals and clinicians offering it for cheap or free knowing that they will pickup more patients. So if insurers ever want to "lose" that expense, they would still have to pay for treatments at those facilities and they can certainly build screening into their costs to treat.

Tony
Posted 8/21/2013 11:12 PM (GMT 0)
The USPSTS recommendations on breast cancer screening got squashed. I think using the dangers of the USPSTS guidelines as a threat of what might come is akin to heading into battle with a losing mentality.

Science can go both ways, Tony. There will be differences within the scientific community, and you can make arguments on both sides of the issue scientifically. Screening on your science, for instance, is not consistent with the science Ralph presents to make his arguments for screening.
Posted 8/21/2013 11:20 PM (GMT 0)
davidg,
"The USPSTS recommendations on breast cancer screening got squashed."

No it is still in place. The SGK group and the Oncology groups are against it and it has had little impact on screening women. Same as PCa.

www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm

The part that was challenged was when the USPSTF announced that they no longer support mammography at age 40 with a Grade C recommendation (Weak evidence). They did remove that Grade C recommendation and have now taken a stance that it's lacking evidence to make a recommendation.

But the practitioners are still busy screening 35yo women.

Tony
Posted 8/21/2013 11:25 PM (GMT 0)
Tony - Women did not take the crap the USPSTS unleashed on them as lightly as men did with their horrible recommendations vis-a-vis PCa screening.

If men were half as vocal about PCa as women are about breast cancer the USPSTS would have been ridiculed and the AUA not inclined to compromise their own previous positions.
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