The Profit Motive for Over-Treatment

My urologist charged the insurance company 7K for my biopsy. I'm sure he didn't get that much.

I've read first hand accounts of folks of AS for 5+ years who add up the costs of their management strategy and it rivals surgery costs. Imagine a successful management strategy over the course of 10+ years which would be very common according to you in young guys with low grade indolent bad cell syndrome.

Also, some 40% of AS participants drop out after a few years (forget exact cut off) Those guys end up paying for 2-3 years of AS and treatment. They're an even bigger burden on the system for those who worry about that angle.

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40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

Peter,

I think you are making a good argument for an improved, and perhaps less costly AS protocol. Let's say that biopsies were only done after eliminating confounding sources of PSA, such as I proposed in an earlier post:

Over-biopsying
This would eliminate many insignificant cancers that are now being treated or put on AS.

• Then add $600? for a Bostwick/Epstein re-read.
• Then a CDUS/mpMRI/saturation biopsy at one year (which might have picked up your Gleason 9). This would add maybe $700-$1,500? to the cost. (I'm guessing at the costs)
• Then, repeat every other year if there is sign of progression, or every 5 years if there is no sign of progression.

Since most GS6s do not progress, such a protocol might actually cost less while detecting more progression.

Billy,

You are correct, but give the conversation 10 minutes (at best) before someone throws in politics, and kills the thread.

I would love to be able to discuss delivery mechanisms, but as they are so associated in the US to specific parties/presidents, it can't happen.

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Moderator - Prostate Cancer
(Not a medical professional)

DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808
HT (Lupron) 6-mo injection 9/12;Prolia 6-mo inj 12/12

FrackMe said...  I'm curious why Dr. Samadi chose to move to Lenox Hill. It's usually not ranked up near the top... Larger PR staff to support him.   Maybe not; just sayin'.   What? Did you not know that hospitals have a PR staff?  How about a "Chief Marketing Officer."  Talk about motivated by profit; read on...     Samadi has taken flack previously for his "advertorial" (advertisement looking like an editorial) approach, and the whole (Mount Sinai) hospital got a black eye.   Even the marketing & advertising world has raised it’s eyebrows regarding the ethics of what have been going on there which was considered by others to be “misleading advertising.”   One article, titled “ Spun Silly:   Academic Medical Center Cancer Treatment Advertising in the Era of Hype and Flim-Flam ,” took direct aim at the Samadi advertisements claiming “the highest cancer cure rates with the lowest risk of side effects.”   When approached by the NYTimes, the hospital admitted that it could provide no studies that showed the doctor’s results were superior to those of other hospitals or surgeons.   Under pressure, they later tweaked the promotional wording to say Dr Samadi’s approach gives “high rates of success coupled with lowered risks of side effects.”   Later, they defended their approach saying cancer treatment ads tend to play more heavily on emotion than medical statistics (we’ve seen that) because the ads are “meant to make an impression on future patients.”   The president of the ad agency that produced the Mount Sinai ad said, “This isn’t retail advertising.   This is reputation advertising.”   The Mount Sinai Chief Marketing Officer recently stepped down (2012) from her role as after the firestorm triggered by the brand-building and integrated multi-media advertising, marketing and press strategy campaign. What may confuse “buyers” (like us) is that medical centers are exempt from advertising constraints which put limits on others through FDA and FTC regulations because of their non-profit claims.   If a drug maker ran an ad for a cancer medicine, the FDA would require the company to support superiority claims with substantial evidence from rigorous clinical trials.   But the federal agencies cannot limit the ad claims made by non-profit medical centers.   In medical science, the anecdotal claims of the Samadi ad would not be considered valid ; but, ads for non-profit medical centers are not held to any standard of evidence.   It’s worth considering that the reality that Mount Sinai is a very good hospital, and Dr Samadi is probably an outstanding surgeon.   Anyone “misled” by their ads is nonetheless, if they end up being a patient, going to likely end up getting excellent care.   So maybe not much harm is going to be done...perhaps a "victim-less crime."   It’s hard to imagine getting too cranky about being “tricked” into getting treated at Mount Sinai.   But consider the ethics in the big picture:   these hospitals are likely ‘industry leaders’ in more ways than one. They set the tone for advertising by other hospitals, probably including ones providing a much, much lower standard of care. Now how do you feel about the original topic of this thread ... profit motive for over-treatment as it overlaps with misleading advertising and the realization that your emotions have been the target of slick multi-media marketing campaigns?   (Clearly intentional "misspelling" of Samadi's name changed. Rule three applies, even if the person being flamed is not a member here. - 142)   Post Edited By Moderator (142) : 6/18/2013 2:32:25 PM (GMT-6)

I am not a big fan of Dr. Samadi, but I must say that calling him Dr. S*amadi is disrespectful. It adds nothing to the level of discourse.

Tim, thanks for the compliment.  I guess it's even true that in some places nurse midwives also do deliveries of pregnancies that are not high risk.  You must be very proud of your daughter.

FrackMe said... I am not a big fan of Dr. Samadi, but I must say that calling him Dr. S*amadi is disrespectful. FrackMe, and others interested in a historical perspective of HW, there is a track record that was cemented before you joined HW.   Since only a few of the regular participants in today’s HW/PC could recall this, I will recount it here, in brief, with just the facts and without adding any opinion of my own.   With some regularity (perhaps every 3- or 4-weeks or so, in my recollection), the HW/PC site would get a newcomer who would post just once then typically (not always) disappear.   The posts were from different pseudonym member names, but they were “surprisingly” similarly worded…as if they all came from the same script .   They would heap overly-generous praise on Dr Samadi, claiming that he “saved their lives,” sharing the details of the miraculous, near-instantaneous recovery that they made from surgery, and quoting the doctor’s stratospherical success rates.   Some of those posts even included the doctor’s contact information…just in case you might be looking/interested.   Several HW members who also participated on other PC-related social media forums reported here that identical messages were concurrently showing up on those other sites, and again noted that they were oddly similarly written. These fly-bys were nearly as frequent as we would get other one-time posters claiming that their cancers were miraculously cured by drinking toad piss, and that vials of toad piss could now be ordered online now by going to their website…or perhaps it was some other similarly informative, and perhaps tempting, experiences.   Thankfully, HW/PC has a very active & empowered “spam police” which quickly tags such threads as likely “spam” so that the young & naïve do not fall prey to the nefarious intent of these scum suckers.   For added contextual perspective, please note that these were occurring in the early days of the overtreatment “awakening.”   The “awakening” tipping point was (my opinion) the publication of the Scholz book “The Invasion of the Prostate Snatchers” in summer of 2010…a full year before to the USPSTF “wake-up call.”   Six m onths before the book’s publication, in a March 6, 2010 HW/PC thread , I wrote, “ By the way, brace yourselves for the tsunami of ‘overtreatment’ discussions heading this way later this year when the Dr Mark Scholz book titled ‘Invasion of the Prostate Snatchers’ gets published .”   Was I prophetic, or what?! It was in Schulz’s book and other publications that certain doctors were beginning to get “called-out” by the media, the public, and other doctors for preying on (in particular) fears and emotions of the naïve, uneducated patients, many of whom were young with tiny amounts of clinically detectable PC which never would have been treated in the past (see my comment above about “this is not your father’s PC”), for reasons with disturbing undertones of economic self-interest…which is, of course, the direct linkage to the subject of this thread. So, with fairly clear, but albeit circumstantial, confidence of the "spam police," the fly-by posts of Dr Samadi’s patients got labeled as “spam.” In the end, many HW members agreed that the doctor’s skills were unquestionably high, but his apparent multi-media advertisement/recruiting practices (targeting the confidences of the young & naïve?) appeared distasteful to most.   It did, however, spark some creativity amongst us.   Brother zufus created this ditty (and I will go ahead a change the name's spelling away from the now-viewed “offensive” version, which was in the original wording): zufus said... Dr. S amadi now he's the best He gets the cancer where it rests You'll be cured and feelin' fine Back in the sack and making time Little Willie feelin real woody No E.D., you wonder, how he couldy Remove the gland and make you 'the man' Does 5 a day and makes $100,000 gran' Now give a referral and that's his plan What a doc and what a man See his videos and on t.v. This is the doc for you and me!!!   Post Edited (Casey59) : 6/19/2013 3:10:23 PM (GMT-6)

The Zufus ditty is quite witty.