A key government health panel has decided it says. Ok. I give. Sent from my iPhone
On Apr 10, 2012, at 5:48 PM, "Morken, Timothy" <timothy.mor...@ucsfmedctr.org> wrote: > From the New York Times: > > 1) > U.S. Panel Says No to Prostate Screening for Healthy Men > By GARDINER HARRIS > Published: October 6, 2011 > > > Healthy men should no longer receive a P.S.A. blood test to screen for > prostate cancer because the test does not save lives over all and often leads > to more tests and treatments that needlessly cause pain, impotence and > incontinence in many, a key government health panel has decided. > > The draft recommendation, by the United States Preventive Services Task Force > and due for official release next week, is based on the results of five > well-controlled clinical trials and could substantially change the care given > to men 50 and older. There are 44 million such men in the United States, and > 33 million of them have already had a P.S.A. test - sometimes without their > knowledge - during routine physicals. > > The task force's recommendations are followed by most medical groups. Two > years ago the task force recommended that women in their 40s should no longer > get routine mammograms, setting off a firestorm of controversy. The > recommendation to avoid the P.S.A. test is even more forceful and applies to > healthy men of all ages. > > "Unfortunately, the evidence now shows that this test does not save men's > lives," said Dr. Virginia Moyer, a professor of pediatrics at Baylor College > of Medicine and chairwoman of the task force. "This test cannot tell the > difference between cancers that will and will not affect a man during his > natural lifetime. We need to find one that does." > > Article continues.... > > > 2) > > > Prostate Test Found to Save Few Lives > By GINA KOLATA > Published: March 18, 2009 > The PSA blood test, used to screen for prostate cancer, saves few lives and > leads to risky and unnecessary treatments for large numbers of men, two large > studies have found. > > > Mortality Results from a Randomized Prostate-Cancer Screening Trial (The New > England Journal of Medicine) > Screening and Prostate-Cancer Mortality in a Randomized European Study (The > New England Journal of Medicine) > > > The findings, the first based on rigorous, randomized studies, confirm some > longstanding concerns about the wisdom of widespread prostate cancer > screening. Although the studies are continuing, results so far are considered > significant and the most definitive to date. > > The PSA test, which measures a protein released by prostate cells, does what > it is supposed to do - indicates a cancer might be present, leading to > biopsies to determine if there is a tumor. But it has been difficult to know > whether finding prostate cancer early saves lives. Most of the cancers tend > to grow very slowly and are never a threat and, with the faster-growing ones, > even early diagnosis might be too late. > > The studies - one in Europe and the other in the United States - are "some of > the most important studies in the history of men's health," said Dr. Otis > Brawley, the chief medical officer of the American Cancer Society. > > In the European study, 48 men were told they had prostate cancer and > needlessly treated for it for every man whose death was prevented within a > decade after having had a PSA test. > > Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering > Cancer Center, says one way to think of the data is to suppose he has a PSA > test today. It leads to a biopsy that reveals he has prostate cancer, and he > is treated for it. There is a one in 50 chance that, in 2019 or later, he > will be spared death from a cancer that would otherwise have killed him. And > there is a 49 in 50 chance that he will have been treated unnecessarily for a > cancer that was never a threat to his life. > > Article continues.... > > -----Original Message----- > From: Kim Donadio [mailto:one_angel_sec...@yahoo.com] > Sent: Tuesday, April 10, 2012 2:33 PM > To: Morken, Timothy > Cc: Daniel Schneider; Histonet > Subject: Re: [Histonet] In House Labs in WSJ > >> Less screening = fewer biopsies = less revenue = less prostate cancers >> caught early = more deaths to prostate cancers. > > Would you not agree? > > And for all those advocating closure of private labs, do you also feel the > same way about private pathologist owned labs who reep the benefits of > getting all the out PT work from affiliated physicians while they also get a > fee to serve as medical directors of hospital labs and get the pc portion of > hospital work of which they can order as many test they want so they get the > pc portion while the hospital gets the tc and all the big bills associated > with doing the test making it hard on tax payer as well because so much in a > hospital is already subsidize by the gov. > > Is what you really want is to have all pathologist as employees of the > hospitals? And have the hospital bill global. > > And a few walmart like reference labs > > I'm just curious as to the exact position of some on here. > > Thanks > > Kim > Sent from my iPhone > > On Apr 10, 2012, at 2:39 PM, "Morken, Timothy" > <timothy.mor...@ucsfmedctr.org> wrote: > >> Not surprising since our health care system is biased to pay for tests and >> treatments, not results. On top of this there are serious questions as to >> whether the PSA screening that leads to biopsies is useful in the long term. >> There is a recommendation out there to stop PSA screening for most men since >> it is largely non-specific. That test is what leads to the biopsies. Less >> screening = fewer biopsies = less revenue. >> >> Tim Morken >> >> >> >> -----Original Message----- >> From: histonet-boun...@lists.utsouthwestern.edu >> [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Daniel >> Schneider >> Sent: Tuesday, April 10, 2012 11:22 AM >> To: Histonet >> Subject: [Histonet] In House Labs in WSJ >> >> The Wall Street Journal served up a timely article for us. >> You'll see both sides of the argument below. One side is right. >> >> DLS >> >> HEALTH INDUSTRY >> April 9, 2012, 7:22 p.m. ET >> Prostate-Test Fees Challenged >> >> By CHRISTOPHER WEAVER >> Doctors in urology groups that profit from tests for prostate cancer order >> more of them than doctors who send samples to independent laboratories, >> according to a study Monday in the journal Health Affairs. >> >> The study found that doctors' practices that do their own lab work bill the >> federal Medicare program for analyzing 72% more prostate tissue samples per >> biopsy while detecting fewer cases of cancer than counterparts who send >> specimens to outside labs. >> >> Hiring pathologists boosts revenue for a practice and creates a potential >> incentive to increase the number of tests ordered, said Jean Mitchell, a >> Georgetown University economist and author of the study. >> >> That fewer cancers were detected-21% versus 35% for those sent to external >> labs, according to the study-suggests "financial incentives" >> may play a role in decisions to order the tests, Ms. Mitchell said. >> >> Some urologists said the research doesn't necessarily indicate financial >> motives. Urologists in larger group practices that have in-house >> pathologists may be more aggressive in testing because they seek to catch >> cancer earlier, said Steven Schlossberg, a Yale urologist who heads a >> health-policy panel for the American Urological Association and wasn't >> involved in the research. Also, Dr. Schlossberg noted, the figures, which >> cover 36,261 biopsies from 2005 through 2007, are five years old. >> >> The study was financed by the College of American Pathologists and the >> American Clinical Laboratory Association. It is the last salvo in a turf war >> between laboratory companies and physician groups that have opened their own >> labs to conduct tests. >> >> Regulators and economists scrutinizing the growing costs of health care have >> targeted a range of related activities by doctors, known as self-referrals. >> >> Although a set of 1990s-era laws, named for their proponent, Rep. Pete Stark >> (D., Calif.), ban doctors from referring patients to most companies in which >> they have a financial interest, urology groups can enter the pathology >> business because of an exemption for certain services performed within >> physicians' offices. The pathologists and other groups are lobbying Congress >> to end the exemption. >> >> At issue in the study is a quirk of billing for lab procedures. Labs get >> paid based on the number of jars used to hold specimens from a prostate >> biopsy. Doctors can choose to put several specimens in one jar or put each >> in its own jar, potentially boosting lab fees, which averaged about $104 a >> jar in 2010, according to the study. >> >> Urologists in practices with in-house pathologists sent 11.4 jars per biopsy >> for testing versus 5.9 jars per biopsy for other doctors in 2005. >> >> >> Some doctors say that separating the samples can help them better map any >> cancer. >> >> In addition, urologists in recent years have been taking more samples during >> a biopsy to better identify the location of any cancer, said John >> Hollingsworth, an assistant professor of urology at the University of >> Michigan. The standard number of samples taken doubled to 12 over the last >> decade, he said. >> >> The Health Affairs study's conclusions are "largely around billing >> practices, not around clinical practices," said George Kwass, a pathologist >> based in Massachusetts and board member of the College of American >> Pathologists. Urologists who team up with pathologists appear to bill more, >> he said, leading to potential waste. >> >> Urology groups are consolidating, and increasingly moving into the pathology >> business. One large practice based on New York's Long Island, Integrated >> Medical Professionals, opened its lab in 2010 to control costs and because >> doctors encountered errors in outside test results, said the group's >> chairman, Deepak Kapoor. >> >> "We don't make a fortune on pathology," Dr. Kapoor said. >> >> But lab businesses are seeing revenue vanish. Texas pathology group ProPath >> stopped getting prostate tissue from large urology groups more than four >> years ago, said executive director Krista Crews, when these clients began >> doing lab work in-house. The group still gets referrals from small, one and >> two-doctor practices, she said. >> >> Large laboratory companies are worried about the trend, too. Quest >> Diagnostics Inc. DGX -2.52%said in its latest annual filings that if >> physicians, including urologists as well as gastroenterologists and skin and >> cancer doctors, continued to "internalize" testing services, it could reduce >> the company's sales. >> >> Write to Christopher Weaver at christopher.wea...@wsj.com >> >> Copyright 2012 Dow Jones & Company, Inc. All Rights Reserved >> >> This copy is for your personal, non-commercial use only. Distribution and >> use of this material are governed by our Subscriber Agreement and by >> copyright law. For non-personal use or to order multiple copies, please >> contact Dow Jones Reprints at 1-800-843-0008 or visit >> _______________________________________________ >> Histonet mailing list >> Histonet@lists.utsouthwestern.edu >> http://lists.utsouthwestern.edu/mailman/listinfo/histonet >> >> >> _______________________________________________ >> Histonet mailing list >> Histonet@lists.utsouthwestern.edu >> http://lists.utsouthwestern.edu/mailman/listinfo/histonet > _______________________________________________ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
