Spending Other People’s Money

There is no evidence that any one of these therapies is any better than any other for Medicare prostate cancer patients.

Comments (7)

Trackback URL | Comments RSS Feed

  1. Ken says:

    Amazing. And I believe that Medicare pays for everyone of these.

  2. Linda Gorman says:

    A typical article from the New York Times that tells only part of the story and is filled with qualifiers at that. First, it limits the discussion to slow-growing, early-state cancer. Second, it does not say how many people with that, if any, opt for the more expensive treatments. We have no idea whether access to the more expensive therapies is abused. Third, abuse is assumed.

    What we do know, and the author did not see fit to mention anywhere in an article that defines successful health care reform as limiting access to expensive treatments, is that countries with government run health care systems have markedly lower rates of prostate cancer survival. Maybe doing nothing, also known as “watchful waiting” whether on a waiting list or waiting for the cancer to spread, actually does kill people.

    “Rigorous research,” the lack of which the article deplores, is code for randomized clinical trials. Why the article does not see fit to mention that there are a number of ongoing trials on prostate cancer therapies is a mystery.

    Nor does the author see fit to inform the reader that many of the therapies he deplores are relatively new–too new for large scale randomized studies to have been completed–and are efforts to find ways to treat cancer that mitigate the sometimes serious side effects of current treatments. The first hospital based proton treatment center in the US was built in 1990. IMRT wasn’t approved until 1996.

    Instead the author slimes physicians and hospitals, implying that the treatments that cost a lot of money are more popular because physicians and hospitals get paid for “how much care they provide, rather than how well they care for their patients…”

    People not in the tank for government health care might think that part of doing a good job of caring for patients is mitigating the nasty side effects of a particular treatment, even if it costs more.

    Of course this article ignores side effects completely. Instead, it claims that the different treatments have “roughly similar benefits” which, one presumes, is equal longevity or something. We aren’t told what, and whatever it is, it doesn’t seem to benefit the prostate cancer victims who, as a group, have lower survival rates in countries with government run health care.

  3. Greg says:

    Wonderful commentary, Linda. As usual, you are right on point.

  4. Bruce says:

    Very good, Linda.

  5. Brian says:

    I too think your comment is spot on. Linda. I would however also point out that it is a certainty that the dollar price of each treatment is GROSSLY underplayed. It certainly costs far more than just $2400 a year dealing with cancer of any sort. Whyu do conservatives always try to minimize problems rather than admiting there is a problem and fix it? Rather the reliance on fear and lies makes me sick enough to go to the doctor except I don’t have a spare $700 dollars to do that and insurance probably would ask me if I ever had a sick stomach and brand it as a pre-existing condition and refuse to pay. It is past time we had good healthcare and without the rationing and interferance of insurance agents who’s only care is how much money they can make.

  6. Charles says:

    Great points from Linda. However, what is the data that prostate cancer survival rates in single payer countries is worse? Most of the data I have seen has shown quality is overall better and cancer survival rates same or better (eg http://www.ajph.org/cgi/content/abstract/90/12/1866)

  7. Linda Gorman says:

    Data on Europe come from the EUROCARE studies. As summarized in Medscape in 2007 at http://www.medscape.com/viewarticle/561737:

    “…Survival was significantly higher in the United States for all solid tumors, except testicular, stomach, and soft-tissue cancer, the authors report. The greatest differences were seen in the major cancer sites: colon and rectum (56.2% in Europe vs 65.5% in the United States), breast (79.0% vs 90.1%), and prostate cancer (77.5% vs 99.3%), and this “probably represents differences in the timeliness of diagnosis,” they comment. That in turn stems from the more intensive screening for cancer carried out in the United States, where a reported 70% of women aged 50 to 70 years have undergone a mammogram in the past 2 years, one-third of people have had sigmoidoscopy or colonoscopy in the past 5 years, and more than 80% of men aged 65 years or more have had a prostate-specific antigen (PSA) test. In fact, it is this PSA testing that probably accounts for the very high survival from prostate cancer seen in the United States, the authors comment…”

    The Amer J. Public Health article that you cite compares survival rates of samples in Toronto and Honolulu, not the US and Canada. The data are from the late 1980s. A footnote says “Within- and between-country comparisons among adult cancer case patients 65 years or older are excluded from the table because all except 1 of them (reported in the text) were not minimally statistically significant. Because
    statistical power is clearly insufficient to detect meaningful between-country differences among relatively young men with prostate cancer, this exploratory subanalysis ought to be interpreted with extreme caution until it is either confirmed or refuted with larger samples.”