NYT article - prostate cancer "acid test"

[trublu]

Accurate glimpse of how some view our field, in my opinion:

http://www.nytimes.com/2009/07/08/business/economy/08leonhardt.html?partner=rss&emc=rss

Be sure to check out the comments. Here are snippets from a "good" one:

"[Radiation Oncologists] a few years ago averaged $150,000 annual income. Last year (not a banner year for most others) the average income for a radiologist approached $400,000 ($391,000).

There is currently a shell game going on at every level of information being made by the medical cancer establishment designed to deliver high cost radiation therapies and adjuvant (so-called 'preventative') treatment therapies designed to 'sell' these high cost post operative treatments to a consumer group that has already been traumatized by the basically dehumanized and dollar motivated monstrous system that has evolved in the United States. All of the adjuvant treatment sites prey on the anxiety that "some of those nasty cancer cells may have been left behind . . ." None of them transparently provide who funded the studies that provide statistics, that even a layman can see indicate at best marginal benefits from many of these costly therapies.

It would be enlightening for many if the New York Times ran an investigative series as to what, exactly, the 'scientific' theory is that lies behind the quasi-religious conviction on the part of [Radiation Oncologists] that dosing large quantities of healthy tissue in an individual 'destroys the bad cells' while the 'good cells can regenerate.' For example, those who cannot tolerate the therapies due to highly adverse reactions to it are removed from the 'treated group' and filtered from the final sample. Equally, those who develop other cancers, possibly linked to the radiation treatments, are filtered from such studies.

...And, the debate should be how to provide patients with more honest and less mystified data presented from sources that aren't drug companies and radiation therapist industry representatives trying to pay for their $100,000,000 proton guns."

(sigh)

---

Members don't see this ad.

 

[Gfunk6]

I didn't read through the comments very much, but I absolutely agree with the article which I thought was fairly written.

Low-risk prostate cancer is a $$$ gold mine for both urologists and radiation oncologists. Most people hear that they have been diagnosed with CANCER and freak out. The reality is the oft-quoted saying, "more men die with prostate cancer than of it."

Our institution pushes LDR brachytherapy pretty aggressively using (relatively) inexpensive I-125 seeds as opposed to the Cs monstrosities that are being marketed. The cost is low, much lower than IMRT/protons and even surgery (especially the Da Vinci robotic kind). The outcomes (as we all know) are similar regardless of what therapy you choose.

Like other specialities, Radiation Oncologists went for maximum reimbursement with questionable patient benefit. The time has come to pay the piper for our arrogance.

 

[medgator]

Like other specialities, Radiation Oncologists went for maximum reimbursement with questionable patient benefit. The time has come to pay the piper for our arrogance.

The Proton therapy issue has started to accelerate this to the nth degree

 

[pikachu]

I didn't read through the comments very much, but I absolutely agree with the article which I thought was fairly written.

this would be true if the author of the article hadn't glossed over the not so subtle distinction between low risk prostate cancer in older men with lots of competing comorbidities (which i agree has turned into somewhat of the proverbial cash cow for rad oncs and urologists alike - see UroRads) versus higher risk disease in younger men...

If the author HAD been paying attention, he also probably wouldn't have made the claim that there haven't been any recent trials that show that RT improves outcomes in prostate cancer. this is completely off base as well...even a cursory search of the literature would have turned up the SWOG study that shows a survival benefit for post prostatectomy RT in T3 patients.

In terms of the benefit of IMRT, the author implies that the only side effect which IMRT can improve is diarrhea: "Even if Congress did all this, we would still face tough decisions. Imagine if further prostate research showed that a $50,000 dose of targeted radiation did not extend life but did bring fewer side effects, like diarrhea, than other forms of radiation. Should Medicare spend billions to pay for targeted radiation? Or should it help prostate patients manage their diarrhea and then spend the billions on other kinds of care?" I think most of us are aware that rectal bleeding is in fact the major toxicity that we're preventing when using IMRT for dose escalation in prostate cancer.

and, good luck with "Comparative Effectiveness" studies in a disease with a > 10 year natural history...it will be another 20 years before we see the final results on the currently open trials (hypofx etc)...by then the decisions regarding how we can treat our patients will already have been made, probably by people as ill-informed as the guy who wrote this article...Note that the two M.D.'s who were quoted for the piece were a pulmonologist and an infectious disease specialist! The other "Dr." is a pharmacologist. Now I know that there aren't THAT many radiation oncologists out there, and we're pretty busy bankrupting the US healthcare system by actually offering treatment to men with prostate cancer </sarcasm> but could this guy at least have spoken to an actual oncologist for the article?

this is not to say that we may not be over-treating many men with prostate CA. However, carelessly researched articles such as this are not the jumping off point for making such judgments.

 

[Brim]

It looks weird seeing it written with periods like "I.M.R.T." but I guess that's the N.Y. Times' style.