At long last men are pushing back against the prostate cancer treatment industry’s decades-long scare tactics. A really good NYT story documented a rapidly-growing trend among men to practice “watchful waiting” when diagnosed with some forms of prostate cancer. The money quote: “Five years ago, nearly all opted for surgery or radiation; now, nearly half are choosing no treatment at all.”
HealthNewsReview posted a thoughtful piece about the facts, research, and trends – well worth a read.
I’d note that this has long been known, but docs – especially those in private practice – were loathe to discuss non-aggressive treatment with patients. Couple of points to ponder – is this because remuneration for watchful waiting is paltry compared to aggressive techniques, and/or a fear of litigation?
Key to the trend towards watchful waiting is an understanding that not all cancers are the same. Especially with prostate cancer. This is a relatively common condition among older men, with a very high survival rate regardless of whether the patient got aggressive treatment or not.
And, that “aggressive treatment” may result in impotence and/or incontinence.
Another key to this is understanding that the diagnostic and treatment industry is very big, very lucrative, and very willing to use its money to preserve its profits.
After research assessing the effectiveness and outcomes of patients treated with watchful waiting vs aggressive surgery documented no significant difference, it still took years for docs in private practice to get with the program and start discussing the watchful waiting option with patients.
So, what does this mean?
- Medicine in this country is a for-profit industry.
- That industry is heavily vested in aggressive diagnosis and treatment options.
- It is very powerful and very persuasive, and quite willing to advocate potentially harmful treatments.
- It takes years to get patients and providers to change, especially when confronted by the lobbying efforts of the medical-industrial industry.
- Like anything else, there’s much benefit from the capitalist approach, and much to be worried about.
But we don’t need to be impotent.