I will be on Science Friday today, sometime between 3:30 and 4:00 PM EST, with Ira Flatow. In New York, it will be on WNYC, on KQED in San Francisco at their time for the show (a three-hour time change). Check your local listings, or listen at your convenience on their podcast.
My last post, The Top 10 Reasons Why Buffett’s Decision to Get Treated for Prostate Cancer Bugs Me, resonated with a lot of people.
As some readers know, I have been writing about prostate cancer for a very long time. I have covered many annual meetings of the American Urological Association, breaking news in medical journals and in Urology Times. Over the years, I have spoken with key opinion leaders in the field. I also ran the urology blog and website at about.com. Like many of you, I have had relatives diagnosed with prostate cancer.
Issues linked to prostate cancer encompass everything from questions about diagnosis and treatment to health reform and reimbursement for medical services. Less hard to discuss in a public venue are concerns about how men feel about treatment: are impotence, incontinence, and quality of life impacted by aggressive treatment? –can you choose no treatment when the healthcare system is built around treatment? Men and their significant others deserve nothing less than the best, unbiased information.
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 looks like The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors will hold a special teleconference/webinar in watch-only mode via teleconference/webinar on Wednesday, April 25, 2012.
The Board will discuss and vote on PCORI’s revised National Priorities for Research and Research Agenda as well as review proposed Pilot Project funding awards.
What: PCORI Board of Governors Meeting Teleconference
When: Wednesday, April 25, 2012
2:00 p.m. – 3:00 p.m. ET
Where: Teleconference & Webinar
No public comment period is scheduled. Once you register, you will receive detailed instructions for joining online and/or by telephone.
A meeting agenda will be circulated and posted on our website prior to the teleconference/webinar.
It’s great to see this move forward, but I have to say it is disappointing that the meeting will have no open discussion.
I hope that on April 25th, the PCORI Board makes it transparent that they truly considered the patient point of view on top-priority patient-centered outcomes research. It would also be most welcome if all remote participants had in their hands, in advance of the meeting relevant materials to reference, so we are truly on the same page as the PCORI Board of Governors.
More details are expected next week, the week of April 17th, when journals address comparative effectiveness research, one of the key strategies for doing patient-centered outcomes research.