Archived posting to the Leica Users Group, 2011/10/29
[Author Prev] [Author Next] [Thread Prev] [Thread Next] [Author Index] [Topic Index] [Home] [Search]Interesting how this emphatically OT thread goes on. Certainly a comment on the makeup of the LUG's primary demographic! Hopper's case was extraordinary. I doubt that one man in a thousand with typical prostate cancer dies of it within 7 months of being diagnosed. Even advanced cases usually respond extremely well to anti-androgen treatment for at least several years. He might have had (this is speculation on my part) a virulent rare form called small-cell carcinoma of the prostate. PSA screening undoubtedly saves lives. How many is the question, and further questions include how much morbidity?incontinence, impotence, chronic radiation-induced proctitis, etc.?is created, how much money spent, how much anxiety caused, totally needlessly, by diagnosis and treatment of non-lethal cases of prostate cancer. Not easy questions to answer, although the answers include the words "a whole lot". The medical community has a lot to answer for, especially (in my opinion) some urologists and radiation oncologists who are often all too eager to do what they were trained to do: treat maximally. I can give you any number of abuses which my partners and I (medical oncologists) have seen, like an 85-year-old man newly diagnosed with prostate cancer confined to the gland itself. This is a perfect opportunity to treat with nothing but reassurance, or at most a $1K office castration, until he dies, almost certainly of something else. Nevertheless, at the urging of his urologist, this man?who has early dementia and impaired comprehension and judgment?chose to undergo robotic surgery for $50K or so, courtesy of Medicare (disbursing your money and mine). We have had similar experiences with aggressive radiation oncologists. Men like him who don't undergo surgery or similarly expensive radiation therapy will almost certainly be started (by their urologists) on a program of an anti-androgen injection every three to six months. The cost of this exceeds $8K/yr, and accomplishes absolutely nothing beyond saving the men from the indignity of castration. Not meaning to offend the personal sensibilities of any LUGgers, I'd have to say that this is an expensive vanity*, considering that the average prostate CA patient who receives this anti-androgen therapy does so for probably between 5 and 10 years, making it even more expensive than radiation or surgery. Here you see one of the pernicious causes of Medicare's rapidly approaching bankruptcy: no mechanism to refuse to pay out (your and my) dollars for the shiny, high-tech, biologically elegant, state-of-the-art therapies that doctors and patients naturally gravitate to and are far more expensive while being no more effective than simple therapies, or maybe none at all. Prostate CA is just a small slice of the whole pie of wastage. Nor does the FDA, like Medicare, have the power to refuse approval of a new treatment or device on the grounds that it is not cost-effective. Such judgments and limits are the inevitable future of medicine, but it's not here yet, although reprehensibly tardy already. My fellow medical oncologists and I are not entirely clean ourselves. We too employ new treatments with enormously high cost-effectiveness ratios?like Provenge, not a region of France but a prostate CA vaccine, which costs $96K and extends survival by an average of, ahem, 4 months. It is paid for by Medicare and private insurors, who have no mechanism for setting cost-effectiveness cutoffs on FDA-approved treatments. What distinguishes us from the above is that we have been put in the position of giving patients the choice of treatment with expensive drugs or nothing, not expensive drugs or cheap equally effective drugs. Rant over. Where's my M3? I've got a roll of Tri-X that wants to see the light... ?howard *The equivalent of Medicare paying $50K for breast augmentation?for an elderly woman. And I reserve the option to revisit this opinion once I've been diagnosed with my own case...as long as the anonymous They are paying! :-) On Oct 28, 2011, at 11:12 PM, Sonny Carter wrote: > On Fri, Oct 28, 2011 at 9:39 PM, Ric Carter <ricc at embarqmail.com> wrote: >> >> I get this on the macro level in which you make decisions for the system > and a large sample of men >> >> on the micro level, just worrying about me, the call is much more > difficult > > > from > http://en.wikipedia.org/wiki/Dennis_Hopper > > "On October 29, Dennis Hopper's manager reported that Hopper had been > diagnosed with advanced prostate cancer.[45] In January 2010, it was > reported that Hopper's cancer had metastasized to his bones." > > "Hopper died at his home in the coastal Los Angeles district of Venice on > the morning of May 29, 2010 at the age of 74, due to complications from > prostate cancer." > > > > > -- > Regards, > > Sonny