David Leonhardt has a July 7th, 2009 front page article in the New York Times: “In Health Reform, a Cancer Offers an Acid Test.” His test is how health care reform will affect prostate cancer treatment costs. Unfortunately, his article is ill-informed and biased to agree with his agenda. Here’s why.
He starts by comparing treatments for what he calls “slow-growing, early-stage prostate cancer.” Unfortunately, the terms slow-growing and early-stage don’t always go together. A fast growing cancer is at some time early stage and the main problem – not mentioned by Mr. Leonhardt – is that no one knows how to distinguish between slow and fast-growing prostate cancer. Although most prostate cancers are slow growing, some aren’t and about 30,000 men die each year from prostate cancer.
So Mr. Leonhardt has already set the stage – how does one treat a non threatening disease since he has framed the discussion around slow-growing, early-stage prostate cancer. He suggests that among the choices are watchful waiting or more “aggressive” options including proton beam therapy which “involves a proton accelerator that can be as big as a football field.” The word aggressive implies overtreatment and big as a football field suggests too much money.
It is somewhat baffling why Mr. Leonhardt would ask Dr. Daniella Perlroth what she would recommend to a family member. Her answer was watchful waiting. Dr. Perlroth, who Mr. Leonhardt said has studied “the data” (which data?), is an infectious disease specialist. Why wouldn’t Mr. Leonhardt ask a urologist or radiation oncologist? Would you ask a baseball player which hockey stick to buy?
Mr. Leonhardt talks about costs – $50,000 for IMRT (a form of photon based radiation) and $100,000 for proton beam therapy. Here, Mr. Leonhardt is silent about his sources. One of the commentators, Sameer Keole who is a radiation oncologist disputes these figures and says “The Medicare cost of treating men with prostate cancer with IMRT is approximately $35,000; the cost for protons is $49,000.”
Mr. Leonhardt has a brief discussion about side effects and says “Imagine if further prostate research showed that a $50,000 dose of targeted radiation did not extend life but did bring fewer side effects, like diarrhea, than other forms of radiation.” Mr. Leonhardt should know that the major side effects to worry about with prostate cancer treatments are incontinence and impotence. Now who wouldn’t want an effective treatment which has fewer of these side effects even if it costs more.
So Mr. Leonhardt will lower the cost of healthcare by providing misinformation to steer people towards a treatment (watchful waiting) that might be OK, also might kill you, but it costs less. He overstates the cost of effective treatments and neglects to mention side effects. This is an opinion or editorial which does not belong on page one. Well, actually because it is so ill-informed, it does not belong in the New York Times at all.