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The Business of Prostate Cancer: Putting Profit before Patients

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By Anthony H. Horan, MDThe Big Scare

The Big Scare

During my 30+ years as a board-certified urologist I’ve seen quite a bit of suffering, much of it needless, in my opinion. In my work both in private practice and with the VA in Fresno, CA. I’ve encountered many men who’ve received treatment for prostate cancer that greatly diminished their quality of life and produced horrible side effects, but did absolutely nothing to prolong their lives. These patients served as the inspiration for The Big Scare: The Business of Prostate Cancer, a book I wrote, hoping to spare men from the over-diagnoses and over-treatment for prostate cancer that’s taking place in this country every single day. I contend that screening for prostate cancer with a blood test and treating the cancer, discovered in the absence of a palpable nodule, offer no measurable good that outweighs the measurable harm. Instead, I advocate interceding before a man is falsely diagnosed with clinically significant prostate cancer.

Prostate Cancer is relatively common disease, with about 260,000 men over the age of 50 diagnosed each year. But as daunting as that number may sound, the fact is that prostate cancer is a very slow moving disease with estimates showing that 94% of the cancers detected with the routine PSA blood test would not even cause death before the age of 85. More men die in accidents than of prostate cancer. The PSA is a test I have major qualms about and objections to. The PSA test has triggered an enormous number of expensive and unnecessary prostate biopsies, which have led to treatments, a rash of radiation and radical surgery injuries, and death. After undergoing radiation, only 55% of men retain erectile function. So this is an issue that not only impacts the lives of many men, but the lives of their significant others as well.

Most of the men over 40 who are reading this blog have heard about or even had a PSA test performed. But that does not mean that it’s a reliable indicator of prostate cancer – because it is not. The PSA test should not be given without first having a long conversation with your doctor – or not given at all. Starting in 1986, just after the PSA test was introduced, many doctors, other than urologists, started buying machines in order to make a profit by doing the tests in their offices. Following this, diagnoses of prostate cancer and its treatment rate started to soar. The biopsy rate quintupled and the number of men labeled prostate cancer victims doubled between 1989 and 1992. Despite this, statistics prove that no more cancers have been discovered since the introduction of the PSA than would have been found in a random series of men the same age – whose PSA is unknown.

You can tell your doctor that you don’t want the PSA test. That’s your right. The only men who should be having the test are those who’ve already been biopsied and diagnosed for prostate cancer. That said, the PSA test is indeed useful for another far more frequent prostate problem, found in ten-times as many men as aggressive prostate cancer. Benign Prostatic Hypertrophy – better known as BPH, is a prostate condition that can create real devastation for men in their later years.

When I went to medical school at The Columbia University College of Physicians and Surgeons and also during my urology residency at the Columbia Presbyterian Hospital in New York in 1973, non-intervention was the rule. We didn’t go looking for the incidental cancers that were of no clinical significance. And if we found them, we did nothing about them. This non-treatment approach came from a Mayo Clinic study that showed a man who is diagnosed with prostate cancer had a survival curve identical to the general population of men. That was the conventional wisdom of the 1960s and it is still true today.

My credo is to treat people as citizens first and as patients second. My humanistic approach to medicine may occasionally put me at odds with my colleagues but has preserved the quality of life for a great number of men, their wives and partners. I believe that for a vast majority of men diagnosed with prostate cancer the best course of action is minimal cryosurgery or no action at all. In order to maintain a good and positive quality of life, people should stop worrying about cancer and learn to enjoy their lives. Living life to the fullest is the guiding principle by which I live my own life and the message I hope to impart to all who visit my medical practice.

Dr. Anthony H. Horan, a board-certified urologist in Delano, California. He has extensive experience in the diagnosis and treatment of adult and pediatric urological conditions. He combines clinical services and expertise with state-of-the-art therapies. He served two years in the Air Force as a general surgeon, one of them in Vietnam. After 10 years in private practice, Dr. Horan spent 15 years as a salaried urologist for the Veteran’s Administration. He has written a book The Big Scare: the Business of Prostate Cancer. Its purpose is to diminish the harm being done to our men and women by the overdiagnosis and overtreatment of prostate cancer.

Health 2.0 – The Consumer Aggregators

The Consumer Aggregator Panel at Health 2.0 San Francisco

Featuring: Roni Zeiger MD, Product Manager, Google Health, Wayne Gattinella, CEO WebMD, David Cerino, Microsoft Health Solutions

Moderator: Jane Sarasohn-Kahn, Think-Health

Overview: With consumers turning to online sources in record numbers, competition is heating up between the giants in the field. In this segment recorded at Health 2.0 San Francisco, key players at Google, Microsoft and WebMD talk about important shifts in the industry landscape over the last year, their companies’ near term plans and the powerful trends likely to shape the way Americans – not to mention the rest of the planet – use the internet to look after their health and search for reliable health information.

Related video:

Gov 2.0: Obama administration CTO Aneesh Chopra talks about the administration’s call for innovation  in Silicon valley and broader adoption of information technology throughout the healthcare system. A must see in light of the national healthcare reform debate and growing investor interest in health IT.

The future of electronic medical records: Electronic medical records may be the most controversial technology around in an area with little shortage of controversey.  In the popular “Cats and Dogs” panel at Health 2.0, the key players in the debate over the future of this crucial technology take center stage in a culminating debate moderated by Health 2.0 co-founder Matthew Holt.  Dr. David Kibbe of the American Association of Family Physicians (AAFP), is an early proponent of electronic medical records who has since publicly reversed his position. Glen Tullman is the CEO of industry leader Allscripts and a commissioner on the board of trustees of CCHIT, the certification body responsible for overseeing much of the electronic medical records industry. Jonathan Bush is the CEO of athenahealth, a relative newcomer that has enjoyed a good deal of success challenging industry orthodoxies.

Who Should Tell Your MD What to Do?

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By PAUL LEVY

In this Wall Street Journal op-ed, Norbert Gleicher suggests that expert panels won’t improve health care because the the quality of the research on which they would base their physician practice guidelines is not reliable. Instead, he suggests that our system can self-correct when experts lead us astray. He asserts that we have a “well working free market of ideas in health care, where effective therapies can rise to the surface and win out.”

I’m somewhat sympathetic to Dr. Gleicher’s point about a government-imposed clinical review process, but he overstates the case about a current free market of ideas. Individual insurance companies and Medicare currently make payment decisions with regard to therapeutic judgments every day. How are they informed, and what are their sets of vested interests? Much of that remains hidden from public view.

Meanwhile, too, doctors and hospital practice what Brent James calls “regional medical mythology,” patterns of care divorced from scientific evidence, based as much on the local supply of specialists and what they learned from their predecessors as any other factors.Continue reading…

European Union Anti smoking Campaign

Note: While the ” ” campaign is a public service announcement, THCB is receiving a relatively modest payment from the European Union to help cover the costs of operating the site. If you are a non-profit, government agency or international organization seeking to reach a monthly audience of 100,000 unique visitors we may be able to help . Please contact Editor In Chief John Irvine for more information. You can reach John at jo**@***************og.com.

Open Letter to Athena

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By SCOTT SHREEVEScottShreeve

Afterburner (af·tər′bər·nər) n.

  1. A device for augmenting the thrust of a jet engine by burning additional fuel in the uncombined oxygen in the gases from the turbine
  2. The augmentation of thrust obtained by afterburning may be well over 40% of the normal thrust and at can exceed 100% of normal thrust

Athenahealth is one of my favorite companies anywhere. I believe they have a great vision, a  highly capable team, an incredible business model, and an unprecedented business opportunity before them. However, for all the amor, I have been disappointed that even with all their blistering success (Bam, Bam, and Kabam!) they have captured less than 2% of the target market since the IPO. I am not just disappointed for them but for the entire ambulatory care space which doesn’t seem to readily get the value of the collective intelligence inherent in the network.Continue reading…

On Stage at Health 2.0: The Cats and Dogs of Health IT

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By Matthew Holt

Here's the first in a series of videos from the Health 2.0 Conference a couple of weeks back that we're going to feature on THCB. This was the last panel of the day and it featured three leading health IT figures who've never been on a panel together before.

Following the passing of the stimulus and the debate over meaningful use, there’s been lots of tension between the “cats” (the major IT vendors) & “dogs” (the web-based “clinical groupware” vendors). (Here's the article I wrote about it last January). The real question is how the new wave of EMRs is going to integrate with the consumer facing and population management tools. Can there be unity around the common themes of better health outcomes through physician and patient use of technology? Or will the worlds of Health 2.0 and the EMR move down separate paths?

On the panel were Glen Tullman from Allscripts, Jonathan Bush from AthenaHealth (in his Apple 1984 runner shorts) and David Kibbe, from the AAFP. A feisty discussion about how IT for doctors and patients should play out.

Link to video

Docs Wash Hands Like Guys In Gas Station Bathroom

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Thursday was Global Handwashing Day

OK, a new study by the London School of Hygiene & Tropical Medicine did not directly compare how often someone washes their hands after using a gas station bathroom and how often your doctor washes his hands before examining you. But, being careful not to touch anything, we can do the math.

The School of Hygiene study just published in the American Journal of Public Health, placed electronic sensors in service station bathrooms along highways in Britain to see the way men and women responded to electronic reminders to wash their hands with soap and water.  After monitoring some quarter of a million people, they found that 32 percent of men and 64 percent of women washed their hands.

Most of the electronic messages caused some improvement in hand-washing, but the one that worked best was, “Is the person next to you washing with soap?” As one researcher told the BBC, “What other people think – what is deemed to be acceptable behavior – is probably a key determinant….It was interesting to see that, for men, the more people there were in the toilet, the more likely they were to wash their hands with soap.”

Which makes the average British male very much like U.S. doctors. As an article by Didet et al. in the Annals of Internal Medicine (and concluded, doctor hand-washing “was associated with the awareness of being observed, the belief of being a role model for other colleagues, a positive attitude toward hand hygiene after patient contact, and easy access to hand-rub solution.”

But at least British motorists aren’t stepping out of the gas station into a surgical gown. A multicenter study in the United States, published earlier this year by McGuckin and colleagues in the American Journal of Medical Quality, found that baseline compliance for following hand hygiene rules was just 26 percent in intensive care units and 36 percent in non-ICUs. After a 12-month “feedback intervention,” compliance increased to just 37 percent for ICUs – about the level of the average guy using a bathroom in a British gas station – and 51 percent for non-ICUs – still below the average female British bathroom user. (No word on whether female doctors washed their hands more than their male counterparts.)

The School of Hygiene study said that men responded best to messages of disgust, such as, “Soap it off or eat it later.” Meanwhile, the World Health Organization estimates that health care-associated infections affect as many as 1.7 million patients in the United States each year, cost $6.5 billion and contribute to more than 90,000 deaths annually.

Perhaps sinks in U.S. hospitals should consider electronic messages of their own, such as, “Soap me before I kill again.”

Michael L. Millenson is the president of Health Quality Advisors LLC and holds an adjunct appointment at Northwestern University’s Kellogg School of Management. He is the author of Demanding Medical Excellence: Doctors and Accountability in the Information Age and, earlier in his career, was a Pulitzer Prize-nominated reporter for the Chicago Tribune.

Good Intentions Aren’t Enough with Health Care Reform

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By SARAH PALIN

Sarah-palinFormer Alaska Governor Sarah Palin’s widely publicized comments on death panels and  rationing this August were among the opening shots of an unprecedented national fight over health care reform. At the time, few sober analysts would have predicted that Palin’s criticisms would gain traction. Yet, they found a receptive audience among conservative opponents of the Obama administration’s health care reform plans, triggering an ugly battle between supporters of reform and right wing opponents.This weekend, Gov. Palin returned to the healthcare debate with another post to her official Facebook page that touches on the talking points you’re likely to hear in the months to come from Republican critics of the Obama administration’s health care reform efforts.  In the spirit of debate we are republishing the post in its entirety. — John Irvine

Now that the Senate Finance Committee has approved its health care bill, it’s a good time to step back and  take a look at the long term consequences should its provisions be enacted into law.

The bill prohibits insurance companies from refusing coverage to people with pre-existing conditions and from charging sick people higher premiums. [1] It attempts to offset the costs this will impose on insurance companies by requiring everyone to purchase coverage, which in theory would expand the pool of paying policy holders.Continue reading…

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