Prostate cancer treatment: The wrong acid test for health care reform

On the front page of today's New York Times, just below a photo of Vladimir Putin, David Leonhardt writes about his "personal litmus test" for health care reform (In Health Reform, a Cancer Offers an Acid Test). His litmus test is different than the typical ideological one, which focuses on whether or not a public plan is included. For him, it's how well the solution deals with the cost of prostrate cancer treatments. In particular, he'd like to see the various prostate cancer treatments --the costs of which range from a few thousand dollars for watchful waiting to $100,000+ for proton radiation therapy-- subjected to comparative effectiveness research and have incentives aligned to encourage cost effective treatment. Right now, the problem is that there is an incentive to perform more costly treatments and little information on what's best.Yet there is a more fundamental issue, which could be addressed by scientific innovation rather than health policy wonkery. And that issue is the diagnosis and management of prostate cancer. Now, men undergo PSA tests followed by biopsies when the number looks bad. Those biopsies can be traumatic and are often inconclusive, leading to more tests, lots of worrying, along with treatments that are often unneeded, expensive and harmful (impotence and incontinence anyone?)A big problem is that some men thought to have "slow-growing early stage prostate cancer" as described in the article can end up dying from the disease. And that's the main reason why such aggressive, costly treatments are pursued.A better emphasis for health care reform would be to focus on providing incentives for the development and deployment of sensitive, specific diagnostic tests that can help determine whether treatment is needed and if so, which treatment is right for the particular individual. What we want to avoid are tests that just add to the uncertainty --driving up costs for testing, consultation and treatment while producing more worry.We should be able to finance even the most expensive treatments when needed --if we can determine when they really are needed.