Are Profits Driving Treatments For Prostate Cancer?

A prostate cancer patient prepares for IMRT treatment. (Upstate Medical University)

Cases in California, Washington, Maryland and South Carolina are leading investigators and Medicare to ask if financial incentives are influencing treatments doctors recommend for prostate cancer.

More and more urologists are recommending an expensive radiation therapy called intensity-modulated radiation therapy (IMRT) for treatment of prostate cancer.

IMRT backers say use is spreading because it works better, with fewer side effects than other technologies.

But urologists like Dr. Matthew Cooperberg of the University of California, San Francisco told Bloomberg news that “IMRT is overused.”

Cooperberg said that “about half the 50,000 men who receive IMRT for prostate cancer each year don’t need it or don’t gain anything from it that exceeds cheaper treatment.”

The prostate is the gland that helps produce semen. About 242 thousand men are diagnosed with prostate cancer each year in the U.S., making it the most common U.S. cancer.

Bloomberg: Prostate Patients Suffer as Money Overwhelms Best Therapy

Guest:

Gary Putka, editor for Bloomberg news.

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ProfessorCook

My urologist recommended I consider watchful waiting, regular surgery, robotic surgery, and radioactive seeds. When I met with the doctor who would probably implant the seeds, I was struck that I had to initiate the conversation. It had never seemed to me to be a good option. I ended up asking him rather bluntly if he thought it was a good approach in my case and he said “no.” I wondered why I had to ask that. Why wasn’t he forthcoming about his opinion after he knew my situation?

In the end, I had the robotic surgery and noticed that the radioactive seed doctor got a pretty handsome fee for our conversation.
Jackie

This type of activity is not limited to only prostate issues. My son had run into some trouble a few years back and was caught with some marijuana. It was recommended that he enroll in an 8 week out patient drug program at a local hospital. When I got the bill from the hospital, it was over $6000. I called 4 other hospitals in our area, and was told a similar program would cost around $3000. The reason our bill was so high? The doctor claimed he was leading all of the meetings, not the social worker who actually was. Insurance had been overpaying for these “services” for many years. Got the bill much reduced, and that doctor is no longer in charge of the drug program at two facilities near our home. But think of the profit he had made!
http://twitter.com/cooperberg_ucsf Matt Cooperberg, MD

As I tried to make clear to the Bloomberg reporter, the problem of IMRT over-utilization reflects the fact that it is reimbursed very highly by Medicare and other payers compared to surgery, brachytherapy, and other treatments that yield equal or better outcomes. It’s not about urologists—the incentives and their impact on utilization exist equally in radiation oncology practices.
-Matthew Cooperberg, MD, MPH
University of California, San Francisco
Concerned

Please investigate this concept of referral to services for profit more broadly in the medical field.
I have heard many stories of recommended services provided by and owned by the physicians who are recommending that practice. In some cases, there are circumstances where patients are told to ‘go down the hall or to the next door office’ for treatment. This referral process to physician owned services can be observed in many communities. It is common with physical therapy and physician owned physical therapy services – most frequently with orthopedic and neurology practices.
http://www.facebook.com/people/Jim-Corcoran/1591985520 Jim Corcoran

Meat is manly? Think again (erectile dysfunction & prostate cancer)
http://www.youtube.com/watch?v=MB0zIg7Kl6A

Diet changes can help protect against prostate cancer
http://www.chicagotribune.com/health/sns-201210231900–tms–premhnstr–k-h20121024-20121024,0,1233157,full.story