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Let’s Revolutionize Prostate Cancer

Let’s Revolutionize Prostate Cancer

A New Approach to Prostate Cancer

It is time.  We need to rationally approach prostate cancer with new tools.  Imaging first — biopsy last.

In 2004 Dr. Thomas Stamey, Chief of Urology at Stanford, published a seminal article, heralding the end of the PSA era.  He was known as the “the father of the PSA.”  This was not greeted with great applause.  He concluded that PSA testing was not an accurate measure of prostate cancer.  In subsequent years, he has admitted the correlation coefficient between PSA testing and prostate cancer is approximately 20 percent.   That is less than even odds that an elevated PSA equals prostate cancer.  (Vigorous sex can raise your PSA up to 40 percent.)

Men are in constant fear of an elevated PSA and its implications.  It’s like watching the Dow.  But the approach has been too slow to evolve.

Let me give you the best example.  Women typically have an annual mammogram — often followed by an ultrasound (it should be the opposite).  If you are diagnosed with a suspicious mass, a wire-guided biopsy is performed.  This is very targeted and limited only to the specific area of interest.   A positive biopsy is now most commonly followed by a lumpectomy.  The story then becomes complicated.

For men, the approach is backwards, and medieval.   A suspicious digital rectal exam, followed by an elevated PSA (greater than 4.0) will inevitably demand a prostate biopsy.  15 years ago this would have been a “4 core” sample.  4 blind stabs.  But over the interval there has been a tendency to increase to 8 cores, then 12 cores and now 16 cores.  Blind stabs through an area that cannot be sterilized.  This can frequently cause infection, bleeding and pain.

It is time for this approach to come to an ignominious end.

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Health Care: The Day After

Health Care: The Day After

It was never about Health.  It was never about universal health care.   Access does not equal care and certainly not quality care.   Yes, one side “won.”   This is not a victory for you.

It is not a left-wing agenda.  It is not socialized medicine.  This is the first time the Federal Government has mandated the purchase of a private party product.  And from the very racketeering group that is the root cause of the problem in the first place.   What a travesty.   Another government subsidy.   Effectively amounts to another “government bailout.”

As Michael Moore wryly said:

The larger picture here is that the private insurance companies are still the ones in charge. They’re still going to call the shots. And if anything, they’ve just been given another big handout by the government by guaranteeing customers. I mean, this is really kind of crazy when you think about it.

This is not the same as a state mandate for auto insurance.

The State of California is unrelenting on this point.  Driving is a privilege!  It is not a right.  If you do not drive, you are not mandated to purchase auto insurance.  Furthermore, the reality is auto insurance does not cost $5000-12,000 annually.

This is the first major landmark piece of legislation in American history that was passed by such a narrow margin without a single Republican vote.   Social Security passed with bipartisan support in 1935 — 81 Republican Congressman and 16 Republican Senators.   In 1965  Medicare passed with bipartisan support —  70 House Republicans and 13 Senate Republicans.  In 2010 there was not one single Republican vote.   And the margin in the House was razor thin — 220 to 212.

It also violates a well-tested political strategy — sell it first to the American people who will then pressure Congress to pass new legislation.  The public is not aboard.   The latest Quinnipiac and Washington Post polls show the public still opposes this landmark Act.

AT&T has already made plans for a $1 billion write-off in advance of cost shifting.   And legal staff is hard at work looking for technical loopholes.  This just in from Robert Peer at the New York Times:

William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: “The fine print differs from the larger political message.  If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost.”

Everyone is giddy about “the win.”   This is only the end of the beginning.

Remember the Telecommunications act of 1996?   It was enacted to guarantee local competition amongst the major carriers.  It never happened.

Now watch this interview with Michael Moore:

Howard Dean Says It’s Time to Kill This Bill

Howard Dean Says It’s Time to Kill This Bill

Howard Dean at his most articulate and unambiguous self.   The time has finally come.    There is nothing left to support.   It’s now face saving time.   It is not about Joe Lieberman.   He’s just become the Mannie Ramirez of the Senate.

“It’s not health care reform … and it’s too bad it’s come this.”

“You are going to be forced to pay, on average, 27% of your money to pay CEOs $20 million a year…”

[starts at about 4:08 into this clip]

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Trying to Put Genie Back in the Bottle

Trying to Put Genie Back in the Bottle

We have seen the emergence of “evidence-based medicine” in the last 10 years.  This has been an effort to further legitimize and give scientific basis to common medical therapies.  A medical version of “show me the money.”  I have always thought this was rather inane, since it presumed that all medicine for the last 2000 years has been unscientific and irrational.  Although the reality is medicine is not nearly as scientific as asserted.  Only 10-20% of medical practice is based on sound scientific principles.   This rankles most physicians who believe that conventional medicine is scientifically-based.  The highest form of medicine is the practiced art using scientific principles and technology.

A series of US Task Force recommendations are being rolled out by the Department of Health and Human Services.  These are well-intentioned and rational.  Examining the literature and epidemiology of medical practices in an effort to determine what is safe, sane, practical and effective.   The trap is “effective” as you will see.

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More economic thoughts

More economic thoughts

It is difficult staying focused.

What is the Democratic message?  We know the Republican message.  What is the goal?

Representative Henry Waxman was featured on the on The daily Show with Jon Stewart last night.  He was asked a simple question — what is the plan?  What is the goal?  A series of litanies followed without a crisp,  definitive answer.

Initially it was about covering 40+ million Americans who are currently uninsured.  But the nagging question, how this will be funded, shifted the focus.  More discussion follows.  Cost cutting.  Cutting waste, fraud and abuse.  All the old litanies.

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Health Care reform: shifting sands

Health Care reform: shifting sands

Watch the bouncing ball.  In an earlier post I cautioned my gentle readers to keep your eye on the ball.  A difficult task.

What is the goal?

The goal started with a political strategy and calculation based on a lofty ideal.  Cover everybody.  It is becoming clearer to more people that coverage alone does not guarantee access nor quality.   Does universal coverage remain the goal?  Or universal access?  At what cost?

Now the debate shifts even more subtly  to insurance reform.  That is probably where the debate should have started.   Remember, I cautioned in some previous posts that the insurance giants and Big Pharma will not lose.  They are the Titans that no one wanted to challenge.

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CNBC Meeting of the Minds (Health Care)

CNBC Meeting of the Minds (Health Care)

Billed as the Meeting of the Minds, a roundtable discussion hosted by Maria Bartiromo.  Attended by Dr. J. James Rohack, MD, President of the AMA;  Angela F. Braly, CEO of Wellpoint (Blue Cross); Dr. Steven Nissen of the Cleveland Clinic; ex-Senator Bill Frist, M.D.; Michael Milken; Jennifer M. Granholm, Governor of Michegan; and John C. Lechleiter, Ph.D., CEO of Eli Lilly. You can see the range and diversity of opinions and philosophies.  There was no one unifying concept.  Enlist this panel to draft special legislation and you would be hard-pressed to see a consensus statement.   Let’s discuss this further in the next thread.

America’s health care system is on the verge of a massive transformation, fueling a debate that has pitted neighbor against neighbor, patients against insurers, and the haves against the have-nots. We’ve demanded reform, but now that reform is raising more questions than answers.

In “Meeting of the Minds: The Future of Health Care” hosted by CNBC’s Maria Bartiromo, CNBC assembles some of the biggest names in the industry and government to advance the conversation and propose solutions to America’s health care crisis. Will universal access lead to lower quality of care? Will our efforts to health care for all stifle business and put America at a disadvantage in the global arena? And what will American health care look like for the next generation?

What is the goal?  A healthier nation? More coverage? Better Access? Cost containment?  How about improved quality of care?  A new paradigm …

Health care reform weekly wrap-up

Health care reform weekly wrap-up

This is worth studying – from the Wall Street Journal.  This is not new.  It is not driven by the current economic crisis.  Keep your eye on the ball and watch the money. This dynamic duo will not lose — large insurance companies and  big Pharma.  That’s why Harry and Louise now favor a new plan.

Also required viewing is Marcia Angell interviewed on this weeks Bill Moyer’s Journal.  She fears a bad plan is worse than no plan at all.  Reference her past accomplishments as Editor of the prestigious New England Journal of Medicine (NEJM) and author of The Truth about the Drug Companies: How they deceive us and what to do about it.

Hillary Clinton was interviewed on Meet the Press.    David Axelrod on Face the Nation.   Not very convincing as he trys to answer the unanswerable.  How to fund the grand plan.  Watch Jim Cooper, who follows.  He may be the weatherman.   [unless you remember Dylan’s most favorite line … from Subterranean Homesick Blues]

end game or round 2

end game or round 2

It has come to this.  This deadline will come and pass.  It will not be met.  What happened?

Strategically, to frame health care reform as the defining and pivotal achievement of this administration was a setup.  The new administration entered under a wave of jubilation and hope.  I shared these sentiments.

In 1964, Lyndon Johnson entered the office of the presidency with a mandate for change.  A mandate to finish what had been started in the three previous years under an inspiring but a feckless young president.  Johnson was the consummate politician.  He knew how to twist arms.  He knew the Senate intimately.  As so aptly put by Linton Weeks of NPR:

President Johnson was famous for staring down, shaming, cajoling, strong-arming, coaxing, sweet-talking legislators into doing his bidding. Johnson spoke directly to lawmakers. Sometimes very directly. Through manhandling and manipulation, Johnson was able to push through legislation affecting public health for the elderly, fair housing, voting rights and other programs that brought sweeping social change.

Obama came in with a new agenda.  This was to be the reincarnation of Martin Luther King or Mahatma Gandhi.  Leading by example.  Without rancor.  But Washington is a shark tank.

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