On April 17th, 81-year-old Warren Buffett told investors that he had very early prostate cancer. The Washington Post headline read: “Warren Buffett Has Prostate Cancer that is Not Remotely Life Threatening.’” Within hours, news accounts said that the story unfolded after discovering a high PSA in a routine appointment. Next, he had a prostate biopsy. A few hours later, news accounts said that Buffett decided to get radiation therapy for prostate cancer. What’s wrong with this picture?
10. He’s an icon who other men will follow, and there is limited (or no) evidence of benefit of aggressive treatment in men as old as Buffett. At 81, his life expectancy is 7.41 years, shy of the 10-year life expectancy mark doctors look for when they recommend aggressive treatment for prostate cancer.
9. Although Buffett can afford whatever care he so desires, it would cost a fortune if tons of men in his age group went for active treatment and there would be little yield and plenty of side effects.
8. For several years, many physician organizations, including those representing the radiologists and urologists (ASTRO and AUA) who stand to gain income from treating older men, have expressed skepticism about the value of treating and screening men as old as Buffett. That’s because prostate cancer is slow-growing. Buffett is more likely to die from something else.
7. There are far better health care investments that would yield better, long-lasting outcomes. Limited healthcare dollars could be spent on things that actually help people.
6. In some circles, the evidence movement is flourishing and medicine is moving towards more of a scientific base. Yet despite years of intensified effort to base medicine on proof of benefit, or evidence, seemingly has not reached one of America’s smartest men.
5.The war on cancer seems very much alive, no matter what the evidence. Even powerful men, possibly more secure, cannot say no.
4. Buffett may well have side effects from the radiation, namely bowel, urinary incontinence, and impotence.
3. Besides being wasteful, it is not going to save his life.
2. The search for an active surveillance icon continues. I was kind of hoping Buffett could have assumed that role. Surgery has its heroic icons: General Norman Schwarzkopf and Senator Bob Dole. Mayor Rudolph Giuliani went with seeds.
1.If the tide shifts and many more older men choose treatment, it will be a step away from science-based medicine.
A previous version of this post had a different point #1. It first appeared at Patient POV.
Laura Newman has been a medical journalist, researcher and blogger for several years. Her blog, Patient POV, aims to take up issues ostensibly important in an era of patient-centered care. Laura has a longstanding interest in health policy and equity. She has written more than 300 articles on prostate cancer and attended at least 10 annual meetings of the American Urological Association, and she will be discussing this post on Science Friday, on NPR, at 3:30PM EST, April 27.
Excellent post! Funny AND true. Laura, you do your best work when you let loose a little.
As an MD-PhD student, I completely agree with Laura, but it would really help her argument if she had ever seen a patient or attended medical school. It’s very easy to criticize what you don’t understand. Again, we need to see a doctor speak up on this so that readers can more easily believe it.
The decision may not have been based on healthcare–the stock price for Berkshire Hathaway would tank if the headline was “cancer untreated because he is likely to die before it would make any difference”
Great post Laura. Your 10 points are right on, as usual.
@tim: your comments on cost assume that he’s actually paying for treatment himself. However, with upwards of 97%+ men his age on Medicare, it’s likely that Medicare (read: taxpayers) paid for his radiation, and with a radiation treatment course costing $30,000…
Imagine if all 80 year olds in this country were screened and the 70-80% who had yet undiagnosed prostate cancer (based on autopsy studies at that age) AND who were going to overwhelmingly die of something else were then treated with radiation at $30k per person (paid for out of our taxable income). That’s a huge pot of wasted money that could have been better spent on any number of high value medical care not being delivered to those in need today (like screening colonoscopies or vaccines for the 45+ million uninsured), or better spent elsewhere (given the coming wave of baby boomers and the Medicare debt explosion within the next decade).
I too am disappointed in Buffett- the least he could have done is made his treatment decision in private. The worst is that now all these men will say “if it’s good enough for Warren, it’s good enough for me” when they get diagnosed with their Stage I prostate cancer at age 75+ (the radiation oncologists must be loving this by the way… I bet this is going to be a very good month for UroRad)
People need to get educated on the trade offs between the decision to collectively fund (through Medicare/Medicaid) low-value health care at current levels, with Buffett’s decision a prime example of that, or do things like pay the interest on our mounting debt and prevent a EuroCrisis in America, and I won’t even mention our children’s education, which we continuously throw under the bus…
Here’s a start (at educating oneself on future trade-offs):
I think its funny that Laura Newman thinks she can read a couple of bulletin board posts about Warren Buffet and all of a sudden she’s an expert on prostate cancer
3. Besides being wasteful, it is not going to save his life.
All your arguments hinge on this one, but you don’t know if this is true or not. Neither does he, and probably never will know, but he doesn’t need to. Statistically, he will die from something else, but his calculation has an n of 1. The benefit may be improbable, but the cost to him of the money is much less than the cost of the same treatment for me or you…since the value of money is relative to the question of who owns it, and therefore what are the possible uses. Since a possible use of money is only possible for you if you own it.
Of course, making the case that he doesn’t really own his money is the necessary and missing step toward where you want to go.
If the tide shifts and many more older men choose treatment, it will be a step away from science-based medicine.”
I woud ask for the reactions of the hardcores at sciencebasedmedicine.org
” In some circles, the evidence movement is flourishing and medicine is moving towards more of a scientific base.”
In SOME circles.