Prostate Cancer Therapy - Doctors making treatment decisions on the basis of money (New York Times)

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Business Side Effects http://www.nytimes.com/2006/12/01/business/01beam.html?ex=1167973200 & en=0c2dfa4dd15b1124 & ei=5123 & partner=BREITBARTProfit and Questions on Prostate Cancer Therapy Maxine Hicks for The New York TimesDr. Shawn Zimberg prepared a prostate cancer patient to receive multiple beam radiation therapy recently in Plainview, N.Y. By STEPHANIE SAULPublished: December 1, 2006The nearly 240,000 men in the United States who will learn they have prostate cancer this year have one more thing to worry about: Are their doctors making treatment decisions on the basis of money as much as medicine? Skip to next paragraph Side EffectsThe Sirens of ProfitsArticles in this series are examining how monetary considerations can influence the ways doctors conduct business and practice medicine. Previous Articles in the Series:New Nerve Test, a Moneymaker, Divides Doctors (Oct. 20, 2006)Heart Procedure Is Off the Charts in an Ohio City (Aug. 18, 2006)Drug Makers Pay for Lunch as They Pitch (July 28, 2006)Indictment of Doctor Tests Drug Marketing Rules (July 22, 2006)Charities Tied to Doctors Get Drug Industry Gifts (June 28, 2006)RelatedSales Pitch for a Treatment (December 1, 2006) Among several widely used treatments for prostate cancer, one stands out for its profit potential. The approach, a radiation therapy known as I.M.R.T., can mean reimbursement of $47,000 or more a patient.That is many times the fees that urologists make on other accepted treatments for the disease, which include surgery and radioactive seed implants. And it may help explain why urologists have started buying multimillion-dollar I.M.R.T. equipment and software, and why many more are investigating it as a way to increase their incomes. Already, dozens of the nation’s 10,000 urologists have purchased the technology for intensity modulated radiation therapy, which is what I.M.R.T. stands for, and some of them are recommending its use for growing numbers of their patients. Critics see a potential conflict of interest on the part of urologists, the specialists who typically help prostate patients choose a course of treatment. The critics say that urologists who can profit from the new form of therapy may be less likely to recommend other proven approaches, which for some older men can involve forgoing treatment altogether. If the patient has insurance, the added expense may not be a concern for him. And like the other treatments, the new therapy can be highly effective. But doctors say that prostate cancer treatments should be tailored to the individual. Compared with seed implants, for example, I.M.R.T. involves a large time commitment, requiring patients to visit a radiation center 45 times over the course of nine weeks.More worrisome for some experts is a concern that the multiple-beam radiation of I.M.R.T. may raise the risk of secondary cancers, although no medical studies have proved such a link. Helping drive the trend is a Texas company, Urorad Healthcare, which sells complete packages of I.M.R.T. technology and services, and hopes to persuade even more urologists to buy them.“Join the Urorad team and let us show your group how Urorad clients double their practice’s revenue,” the company says in a marketing pitch to doctors on its Web site. Urologists who have purchased the new multiple beam systems say they are embracing a superior way to treat prostate cancer. But because there is little research directly comparing I.M.R.T. with the other treatments, there is little consensus among urologists about which approach is best. That is why some doctors worry that I.M.R.T. may be emerging as yet another example of the way financial incentives can influence medical decisions in this nation’s for-profit health care economy.“It’s all money-driven, and it’s a shame medicine has come down to this,” said Dr. Brian Moran, a radiation oncologist in Chicago, who specializes in radioactive-seed implants, in which tiny radioactive pellets are placed into the prostate. His clinic is paid $15,000 or less for the procedure, with the urologist on the case getting about $900.Dr. Eli Glatstein, a professor of radiation oncology at the University of Pennsylvania, said he was concerned that some urologists would steer patients to the new treatment because they owned the technology and could greatly profit from its use.“It’s not illegal to do this,” Dr. Glatstein said. “That doesn’t make it right.” I.M.R.T. was introduced in the mid-1990s and has proved useful for delivering multiple beams of radiation to a small area while avoiding healthy tissue. Like other treatments for prostate cancer, though, it has possible side effects, potentially including impotence. The one certainty about I.M.R.T. is that for doctors who own the technology, it can be much more lucrative than alternative treatments. Medicare and other insurers typically pay urologists only $2,000 or less for performing surgery to remove the prostate or for implanting radioactive seeds. The insurers say the much higher I.M.R.T. payments, which in some cases exceed $50,000, are based on the technology’s cost.Leslie Norwalk, Medicare’s chief administrator, said she was not worried that doctors who invest in I.M.R.T. would use it on patients who require no treatment. “You’re just not going to do beam therapy on someone who doesn’t need it,” Ms. Norwalk said in a telephone interview.But because of the potential conflicts, urologist-owned I.M.R.T. is the type of arrangement that Medicare should be watching, she said.1 2 3 Next Page »More Articles in Business »