Re: Economic Scene - Plan to Cut Medicare Without Stifling Innovation - NYTimes.com [1 Attachment]

[Guest guest]

Carl P wrote:

> I appreciate you taking the time to review the rcogpatients PCa

> comparison " Snapshot " charts. The information you are looking

> for can be found in the body of the site but I will also attach

> it, including all references, to this email.

Thanks. That helps a lot. I apologize for failing to find the

data on the website.

I appreciate the work that you and others put into this. I

appreciate that the patients make no money from this. I

appreciate the sophisticated work that you have done in putting

all of the information together.

However I still have reservations.

On the adjustments to the numbers, I notice that ProstRcision

numbers were multiplied upward by 3.1% to compensate for more

advanced patients, but I see no indication that any other numbers

were similarly adjusted, which I would expect they should have

been. Surely it couldn't be the case that all of the treatment

centers had the same mix of patient characteristics except RCOG,

which treated higher risk patients on average.

I'm also more inclined towards stratified numbers rather than

adjusted numbers, i.e., here are the results for low risk,

intermediate risk, and high risk patients, though I understand

that some of the sources for data may not have provided that.

Stratified numbers are more clearly justifiable than adjusting

the outcome - which makes it look to the average patient that he

has an 86.6% chance of a successful outcome when the data shows

an 84% chance.

Interestingly, the description of ProstRcision:

" Radioactive Seeds followed by Intensity Modulated Radiation

Therapy (IMRT) "

looks similar to the description of one of the others:

" IMRT followed by Radioactive Seeds "

The only obvious difference being seeds followed by IMRT vs. IMRT

followed by seeds.

Do you have a theory about what accounts for the different

treatment failure rates: 29.6% vs. 13.4%, a ratio of 2.2:1?

I know I'm a cynic, but isn't that suspicious to you? Do the

RCOG doctors think that the other clinic can cut its failure

rate in half by giving seeds first, then IMRT?

As far as I know, nobody audits the figures published by the

different clinics. I was told by a prostate cancer researcher

working on PSA bounce statistics that he appealed to a number of

clinics for raw data but not one of the four well known centers

that he approached would show him anything.

They said they couldn't show him anything due to patient

confidentiality issues. He offered to sign confidentiality

agreements and, after all, he was a doctor. They wouldn't do it.

He offered to pay their clerk to black out names on copies of the

medical records before they were given to him. Still no dice.

He appealed to them on the grounds that he was working for the

National Cancer Institute, not one of their competitors, and the

information would benefit the whole cancer community. They

didn't care. Basically, they all told him to get lost.

I'm not saying that RCOG cheats, and as far as I know they are an

excellent place to get treatment. But having statistics better

than anyone else is worth many millions of dollars to them and if

they do cheat on the numbers, they can be very confident that

they will never be caught.

It's the wild west in cancer treatment. Caveat emptor!

Alan