This is a blog by a former CEO of a large Boston hospital to share thoughts about hospitals, medicine, and health care issues.
I read the reports at the link, which reports that the PSA test and treatment is actually reducing the death rate of prostate cancer. Notwithstanding that trend, there are those who argue that it isn't worth the cost to reduce the death rate from the cancer that kills more men than any cancer except lung cancer. Univeral use of PSA testing and other detection processes, and the best life-extending treatment practices, could probably reduce the prostate cancer death rate by 20,000 per year.A resulting reality of that reduced death rate is the increased cost to current stressed programs. It probably costs Social Security, Medicare, and private pension programs an average of $40,000 for every extra year of life of each additional cancer survivor. If those prostate cancer survivors (I am one of them) live an extra 5 years, that is going to eventually add about $20 BILLION per year to those costs, or about $200 billion over the 10-year window that the congress keeps talking about.A similar situation could apply to the H1N1 immunization program. Healthy over-65's are excluded from the program. A recent report of CDC statistics says that 18% of deaths are among those over 65, but less than 15% of the population is over 65. Are we excluded because it will increase the cost of the stressed programs an extra $200,000 per person over our remaining lifetimes if we survive the H1N1 pandemic?
Engineer on Medicare;Your previous comments have shown that you, being an engineer, are a thoughtful and educated person. So why now succumb to unjustified paranoia; could it be the political scaremongers are having an effect?It is true that people have estimated in general that augmenting preventive health care will not generate the predicted savings because people will live longer and therefore cost the health system more. This argument has logic, but I do not see anyone advocating ELIMINATING preventive health care.As to the 2 examples you cite:1. The vaccine exclusion of those over 65 was intended to priortize use of possibly scarce vaccine supplies; you are excluded not because you are old but because people born before the H1N1 influenza pandemic of 1957 are thought to have partial immunity to the current virus; in contrast to younger people, for whom the vaccine is thought to be most helpful. Besides, if you have children, wouldn't you rather have them get the vaccine than you? I will give mine up for my 19 year old daughter in an instant.2. The PSA test's effectiveness is in intense dispute. There are too many contradictory articles to list, but here is one for your perusal. It is entitled: "Screening for prostate cancer: the controversy that refuses to die":http://content.nejm.org/cgi/content/full/360/13/1351Many other articles may be found at nejm.org; use search terms "psa test effectiveness".As you are already a survivor you may know much of this already.Logic always trumps panic. nonlocal MD
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