The Illness Business

BY RALPH BLUM

With privileges come responsibilities. That’s the way it has always been. One of the great privileges in my life has been the availability of Medicare. And the responsibility? To be watchful, careful that I do not take undue advantage of that privilege. For example? Not undergoing a costly procedure that was not absolutely necessary just because I don’t have to pay for it.

I remember in my pre-teen years a series of silly scatological jokes, including book titles like The Yellow Stream by I. P. Daily. Well, recently, I saw an accusing article by Terry J. Allen published in In These Times, and entitled “Urology’s Golden Revenue Stream.” Made me smile. But it also started me thinking about the extent to which some doctors in the prostate cancer field might be favoring profit over good patient outcomes.

I need to point out here that Mark is not and has never been one of those doctors. Care and concern for the positive outcome as well as the quality of life of his patients has always been his priority. And the over-treatment that is driving up healthcare costs as well as exposing men with prostate cancer to unnecessary surgeries and radiation therapy was the main theme of our book—Invasion of the Prostate Snatchers.

So I was alarmed to learn that rather than accessing centralized equipment and sharing costs, physicians are concentrating on their own profits by buying super-expensive in-practice technologies that pay off only if regularly used. As a result, over-treatment is driving up health care costs as well as exposing patients to unnecessary treatments.

The Wall Street Journal recently exposed one example of the public cost of this pattern. About one third of all Medicare beneficiaries diagnosed with prostate cancer now get IMRT—the targeted radiation therapy for which doctors can charge Medicare as much as $40,000 per patient. According to the Journal, some urology practices are paying more than $3 million for “turnkey” IMRT setups, and the sharp rise in IMRT use is partly driven by financial incentives. And given that the necessity for aggressive treatment for many prostate cancer patients, especially the elderly, is controversial to say the least (as far back as 2006 a study in the Journal of the National Cancer Institute found 45 percent of men receiving IMRT were “over-treated”), this seems to me to be an abuse of Medicare as well as abuser of all those men who risked the inevitable unpleasant side-effects of unnecessary treatment.

So, continuing in the spirit of Mark’s and my book, Invasion of the Prostate Snatchers, it also occurs to me that an increased sensitivity to the out-of-control cost of medical care might be an added incentive to newly diagnosed men to avoid the over-treatment so pervasive in the prostate cancer world today.