As a prostate cancer survivor, I sent the following e-mail this morning to Mr. Leonhardt at the New York Times.
July 8, 2009 Mr. Leonhardt: Having been faced with all the prostate cancer options you mentioned today two years ago, and because I chose based on a combination of my own research, calls and meetings with several urologists, and my own gut, I had surgery at the # 1 urology department of a major hospital in the USA, Johns Hopkins. Eight months later I was astounded to discover that one of the best choices I could have made was not even mentioned by any physician I visited (and my own on line research didn't turn it up) - that is the focal therapy treatment offered by the University of Colorado's Health Sciences Center in Denver. A documentary (shown in prime time on the ABC-TV station in Denver, KMGH) is available from the Prostate Cancer Educational Foundation. I beg you to watch it and write about it. Also, talk to the Denver anchor who underwent the treatment which successfully (so far) has eliminated his prostate cancer WITHOUT SURGERY - and that is Mike Landess at KMGH. Simply put, the treatment identifies the prostate cancer through 3D photography (a camera inserted into the prostate through the anal canal), and then computer controlled needles go in a week or two later and secrete liquid nitrogen, freezing the cancer cells to death. Mike is now cancer free, without surgery, drugs, radiation, or whatever. And the treatments were outpatient treatments at a fraction of the cost of surgery. Please write about it.
I'm an oncologist and prostate cancer is always a long discussion. A lot of what we do is based on patient's attitudes. I would spend 1 hour outlining a 20% risk of incontinence, 50% risk of impotence for a 5% decrease in death in 15 years. Most patients in US choose the side effects. Other countries may be different.
1) I may have missed an explanation, so my apologies upfront if so. But why would you focus on prostate cancer as a guide? For one, it affects primarily men; for another, it is not one of the most widespread or costly problems. What about something like diabetes, which in its most widespread form, Type 2, has a range of treatments--diet/exercise to medication, for varied reasons--or Type 2, which requires both, and the availability of treatment is not widespread.
2) The idea of finding the "most effective" is also problematic. It may be useful, but there are invariably people--whose bodies are unique--do not respond to what are considered the "most effective." The generic form of a widespread med, Welbutrin, slowly but surely has been seen to be *not* as effective as the generic, which insurance companies push hard for people to switch to.
The only way we'll get healthcare reform is to make all politicians use the same system as the rest of us. Right now they have great coverage so they don't really know what the rest of us go through when we get sick. Better yet, give them a year with NO healthcare so that they see why we need reform now. Until then, it's an abstract idea they can debate.
I read the piece & thought it was well written & fairly thorough. One question that I have is: How much will the Phase III trial cost to compare the various treatments? How many people at how many centers to get statistical significance?
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