I begin with this interview with Dr. Ablin PSA antigen's discoverer which was published a few months ago (attached). But this is a well known case.
What impact has the introduction of new genetic tests and "biological" drugs (therapy of very aggressive cancers, such as lung etc.) In the sustainability of health systems?
http://www.medscape.com/viewarticle/828854
The problem of preventing and treating prostate cancer in a timely manner is critical to the survival of a high percentage of males reached the threshold of old age. As an economist, I know the problem that arises is that of the cost-benefit of a certain choice of health policy.
The costs are significant when the PSA test is extended to all men over a certain age. The prevention and early diagnosis are expensive, but there are also benefits. The health system saves the more expensive treatments that would result in a late diagnosis.
The same criticism could then do to mammography in the case of females.
Certainly in this period of economic crisis and budget deficit of the state, governance tends to cut health spending and surely prevention and timely treatment will suffer the consequences.
But we also need to look with suspicion just as the opposite extreme. We have seen the case of Angiolina Jolie who requested the removal of both breasts because of familiarity with breast cancer. Here, however, you enter the private sphere involving emotional issues that tend to see death not as a natural end of life, but as an evil to be defeated.
The problem of preventing and treating prostate cancer in a timely manner is critical to the survival of a high percentage of males reached the threshold of old age. As an economist, I know the problem that arises is that of the cost-benefit of a certain choice of health policy.
The costs are significant when the PSA test is extended to all men over a certain age. The prevention and early diagnosis are expensive, but there are also benefits. The health system saves the more expensive treatments that would result in a late diagnosis.
The same criticism could then do to mammography in the case of females.
Certainly in this period of economic crisis and budget deficit of the state, governance tends to cut health spending and surely prevention and timely treatment will suffer the consequences.
But we also need to look with suspicion just as the opposite extreme. We have seen the case of Angiolina Jolie who requested the removal of both breasts because of familiarity with breast cancer. Here, however, you enter the private sphere involving emotional issues that tend to see death not as a natural end of life, but as an evil to be defeated.
We are facing a new era of healthcare treatment costs (HCV, HBV, "biological", parkinson, some of them catastrophic) that will produce a "competition" between patient categories, including prevention actions.
We have the certainty that all the health services (universalistic/mutualistic) can not deal with this increase in spending because of the crisis (or better the economic resettlement ) underway in Europe .
Surely we will see increase of the patient iniquities.
The role of companies is very important but it should be kept in the frame of medical ethics. Offside this frame the influence may be vicious and harmful.
Prostate cancer is a disease men are more likely to die WITH than FROM. Most prostate cancers are very slow growing and don't metastasize. That's why the US Preventative Services Taskforce no longer recommends routine PSA testing and mapping of younger men.
Angelina Jolie's action was a bit extreme, but her mother died of an aggressive form of breast cancer, and Ms. Jolie did the prudent thing of getting tested for the BRCA 1 and 2 genes. The test was under patent at the time (courts have since thrown the patent out), and cost about 2 grand. When she tested positive, she decided to be proactive and get not only the double masectomy, but to get her ovaries removed as well. Since she already has kids (natural and adopted) this isn't as extreme as it seems.
Mammograms for younger women are also no longer recommended by the US Preventative Services Task Force because they are likely to result in over treatment and unnecessary treatment for minor tumors that aren't cancer or that would self resolve due to the type. Only women with a known family history of breast cancer should get routine mammograms now.
This sort of testing IS expensive and a driver of health care inflation. It often results in unnecessary and expensive treatment along with anxiety and pain for the patient.
Unfortunately, vested interests (oncologists, urologists and gyns) decry these recommendations since they're the bread and butter of these specialists. And patients who did have the nastier forms of cancer produce "testimonials" urging everyone to get tested because testing save their life. So fearful people buy into the fear mongering and get testing and procedures they don't need, testing that will prevent very few deaths. Society pays the cost.
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