This article appeared in the New York Times recently.  We responded and wanted to share that response.

In Health Reform, a Cancer Offers an Acid Test:  By DAVID LEONHARDT Published: July 7, 2009

It’s become popular to pick your own personal litmus test for health care reform . . . http://www.nytimes.com/2009/07/08/business/economy/08leonhardt.html?_r=1

Very good points raised in this comment. However, there are a variety of “flaws”in your entire reasoning.

(1) In the case of prostate cancer, or any cancer for that matter, the only truly definitive method for determining ranking of treatments is the classic prospective randomized clinical trial which is blinded.

What does all that mean? That means that both the patient and physician have no idea which treatment will actually be given, or not, until the day the card is pulled.

Now think about that, you just outlined in your example, multiple options of treatment from watchful waiting, to surgery, to other forms of minimally invasive surgery, to radiation to newer treatments. After you have received your fully informed, educated consent which includes pros and cons of ALL the treatments, are you going to enter this study? Are you going to leave your treatment to fate and chance based on the draw of a card?

Are you now getting the picture? It is very, very difficult in the modern world to get informed patients to agree to the type of prospective trial needed when the disease state is cancer or a similarly serious condition.

(2) While you eschew technology and its costs, you might want to compare the status of treatment for several conditions over the past 40- 50 years:

– prostate cancer (your example) – then most men diagnosed due to back pain from BONE METASTASIS. Only treatment, castration. Have you heard of PSA, Zoladex etc well as laparoscopic prostatectomy, robotic prostatectomy, etc?

– heart disease – then, most taking nitroglycerin or digitalis with open heart bypass the main therapy. Have you heard of drugs that not only lower cholesterol but can reverse build up of plaque in the vessels? Have you heard of heart stents, which have made open heart surgery for bypass relatively rare?

– breast cancer – then, diagnosed when patient or doctor found a lump, meaning the cancer had already been there for some time. Have you heard of mammography, and now digital mammography? Have you heard of alternatives to the feared radical mastectomy? Such as lumpectomy or lumpectomy with radiation?What about breast reconstruction with innervated, vascularized flaps based on microsurgical techniques?

– kidney stones – then, painful passage, open surgery, or crude endoscopy. Have you heard of a ureteroscope? Have you heard of percutaneous surgery? Have you heard of an extracorporeal lithotripter?

– peptic/duodenal ulcers -then, a multitude of open surgical techniques and so called “bland” diets, along with over the counter antacids. Have you heard of Tagamet? Protonix? Nexium? Have you heard that bacteria are the cause of most ulcers and that treatment with these acid blockers and antibiotics can resolve most ulcers without ANY surgery? Have you heard that it is almost unheard of to have a major ulcer based open surgery on the schedule anywhere in America today?

I could of course go on and on. But I think you all get the picture.

Here’s the point, only in free society where innovation is celebrated, and rewarded, will these types of advances be possible and continue. Many of the most useful drugs and technologies were discovered essentially by accident while pursing other lines of research.

The United States is the greatest medical engine of innovation the world has ever known. Our system, with all of its flaws, has allowed this to happen.

We do not have health care crisis, we have an access problem mainly caused by policies of health insurers. There a number of simple, minimally expensive steps that our government could take to address this short of some major health overhaul and federalization of the health sector (which is overall, the largest employer in the US).

You might want to check out some of the concepts outlined under “details on the plan” at www.realhealthreform.wordpress.com

So your basis for success is cost control and elimination of mediocre results? It seems you feel that any degree of uncertainty about a treatment earns it the label mediocre. Based on my above examples, I think your term is not only off base, but dead wrong.

As for the cost issue, there are many factors related to that, but you have focused only on the development side. Care to discuss insurance administrative costs? Most of which are unnecessary and due to failure by health insurers to pay providers? Care to discuss the egregious trial lawyer lobby which has allowed frivolous lawsuits to consume dollars and time that could have been spent on the sick? Care to discuss the wasteful, costly actions of our government which have led us to this highly indebted position?

In this debate, all the issues need to be on the table. However, I would hate to think that the outcome of all of our efforts at reform would be the classic, but cost effective, “take two aspirin and call me in the morning”.

www.condron.us     www.bloglines.com     www.blogburst.com     www.blogcatalog.com   www.clusty.com

In Health Reform, a Cancer Offers an Acid Test – http://www.nytimes.com/2009/07/08/business/economy/08leonhardt.html?_r=1