I Want to Choose!

A recent Op-Ed in the New York Times (March 9, 2010) caught my attention. It was written by Richard J. Ablin, Ph.D.

In 1970, Dr. Ablin discovered prostate-specific antigen, an enzyme produced by the prostate. The PSA test is now the tool most commonly used to detect prostate cancer in men.

Dr. Ablin uses his Op-Ed to tell us that his efforts have not worked out for the best. He now sees that he has created a medical “disaster.”

In the second paragraph he laments that the popularity of the PSA test has led to “a hugely expensive public health disaster.” In the final paragraph he says he never dreamed that his “discovery four decades ago would lead to such a profit-driven public health disaster.”

Dr. Ablin has come to the realization that prostate cancer is an over-treated disease. He feels that too many men waste the time of doctors in getting screened, and too many men waste money on treatment. He implores the medical community to stop the “inappropriate use of P.S.A. screening.”

Why did all of this catch my attention?

I'm afraid it’s personal. A month ago I was diagnosed with prostate cancer.

A diagnosis like that will focus your attention. It has also made me aware that I have a stake in our current healthcare debate.

If you are a policy-maker, you look at the healthcare data and try to make an informed decision. If you are an individual unwillingly thrust into the healthcare world, you look at it with a “What’s best for me?” point of view.

In my case, I am assured that I am “typical.” I’m 63 years of age, and that is close to the median age for diagnosis of prostate cancer. From a data standpoint, I get to join the “fraternity” at a time when half the people diagnosed are older than me, and half are younger.

I bring this up to point out that, from the patient perspective, I’m not particularly interested in the statistics. They don’t give me comfort. I am symptom free, but a blood test from my annual physical found that my PSA went from 2.8 to 4.0 in a year. That increase was a “red flag” to my physician, and she sent me to a specialist to have a prostate biopsy performed.

The biopsy came back positive for adenocarcinoma of the prostate.

When you get that kind of news, it sets you back. You realize that your life has a looming endpoint, and you become distracted with thoughts of your own mortality. It requires an adjustment in your thinking.

I am now working through the options for treatment, and am amazed to see that politics is at work in the medical profession. I like the option of surgery, because you get the cancer (hopefully) removed from your body. I can get my prostate surgically removed, placed on a petri dish, and checked to see if the margins are clean. I get first-hand evidence of what is going on in my body.

Radiologists feel that zapping the prostate with electromagnetic energy is the better approach, having a smaller probability of negative outcomes such as impotence and incontinence. However, they have to use secondary evidence (PSA levels) to evaluate the effectiveness of the treatment.

In my case, I am thankful that I have options. I like that the American healthcare system allows me to choose between treatments.

And that brings me to the subject of this post. It is now clear to me what our healthcare debate is all about. It’s a question of having options.

There is no doubt that if you select a prostate treatment “winner” (Surgery is no longer deemed effective! Radiation is the only approved treatment for prostate cancer!) you will have a more efficient (less costly) healthcare system.

But guess what? When you are the person caught up in that system, you don’t want to be driven to a treatment option by politics. You want to evaluate what’s available and make a personal choice based on what is best for you.

That’s why people come to the United States for medical treatment. We still have treatment options.

Now that this whole issue is a bit more personal, I have to say I come down on the side of choice. Here is what I would tell those political leaders who are working to dictate what healthcare system is best for me:

I WANT TO CHOOSE!

It’s as simple as that.

UPDATE 3/16/2010:
Linked by Left Coast Rebel!  Your kind thoughts are appreciated, Tim.