One axiom is certain in medicine: there is always room for controversy. And that’s good, because it spurs further scholarly thought and research — both qualities can only help patients and providers in the long run. With the current discussion in the media regarding the utilization of the PSA in determining the course of action in prostate cancer screening, so many fundamental issues surrounding patient informed consent, unnecessary treatments, and the potential harms from treatments — can serve as valuable teaching points for patients and current and future physicians alike. The discussion — highlighted in the current NEJM — really brings this point home.

Watchful waiting and active surveillance may help prevent the conversion of overdiagnosis to overtreatment, mitigating the harms of screening that are so accurately portrayed by the task force. … we primary care clinicians must ensure there is no more routine, indiscriminate PSA screening — and no washing our hands of responsibility once the patient is referred to a specialist for prostate-cancer treatment. We owe it to our patients to provide them with the kind of guidance about this screening test that they need and deserve…

LINK | USPSTF guidelines on PSA screening here

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A healthcare informatics company issues a report today that I really do not find surprising. The trends of Pharma of late are much fewer fast-tracked medications in the pipeline, decreased NDAs for many novel and like-classed (so-called “me-too” drugs) medications, and — are you ready for this? — much greater healthcare consumer spending on generics, which, according to the report, now make up almost 80 percent of the pharma marketplace.

It would be too easy to blame this on the economy. At the root of this and other findings detailed in the report are forces more complex in the healthcare economy than just the principles of supply and demand. After all, while there are fewer patient visits and greater demand by providers and health systems for payments by third parties, you can bet that Pharma still manages to turn a profit. Just take a look at the volume of sales by therapeutic areas: anti-cancer drugs continue to lead the way.

The top five therapy classes were: oncologics, with $22.3 billion in 2010 spending; respiratory agents, at $19.3 billion; lipid regulators, at $18.7 billion; antidiabetes drugs, at $16.9 billion; and antipsychotics, at $16.1 billion. Growth in spending among these classes ranged from 0.9 percent for lipid regulators to 12.5 percent for antidiabetes medications.

Although consumers, third party payers, hospitals, and providers all appear to be embracing quality provisions as a way to control costs, it is somewhat less clear what this pharmacologic austerity will ultimately mean for the management of chronic disease and how that will impact the cost of healthcare over the next 10 years. | LINK [PDF] to IMS report

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With research findings such as this, is it any wonder why the federal government waited so long to comprehensively cover mammogram screenings?

About half of women whose insurance pays for mammograms actually go in every year for a screening, according to research released yesterday. A study of 1.6 million women who are customers of Medco Health Solutions found that, on average, about 50 percent of women in the plan got an annual mammogram. Numbers were highest for those 50 to 64 years old, but still low at an average of 54 percent.

These numbers have to improve if any cost savings are to be seen in reform provisions championing preventative healthcare delivery. | LINK

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Imagine never having to obtain a colonoscopy for the purpose of cancer prevention and screening. The push to research alternative methods to cancer detection and early treatment in the least invasive way possible has been a holy grail of sorts in this area of preventive medicine. The desire to diminish concerns for a less onerous way of undergoing such testing is matched only by the level of anxiety, embarrassment, and total discomfort it engenders in many patients.

A DNA-based stool screen is able to, at least, stratify patients who need a follow-up colonoscopic screen, sparing patients in whom results are negative from even undergoing the procedure. As stool passes abnormal (pre-cancerous) colon epithelial cells in its wall,^[1] it collects DNA matter which can be quantified by this test to give an accurate result of one’s cancer risk by its detection.

Colon cancer is the second most common cancer killer in the US, and it is hoped that this test is able to lower the cost per detection ratio drastically. Could a home version also be in the offing? The biotech company involved in the test’s development will ready FDA application in 2012. | LINK

1. The test looks for three genes that have been altered in a process called methylation.

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Lately, Doctor Pundit has been reporting some tidbits from the arena of medical research. Here are a few more to make the wires for 9/1.

• Is it really possible? For now you’ll just have to ask the mice taking it. Metformin, the country’s most widely used antidiabetic agent, could lead to the prevention of lung, breast, and prostate malignancies. | LINK
• Speaking of cancers, are certain heritable forms of breast cancer prevented by a certain surgical technique? | LINK
• Again, on the topic of cancer: an anti-tumor drug may be altered to serve as the basis for a novel agent to prevent the formation of senile plaques seen in the central nervous system in virtually all Alzheimer patients. | LINK
• Finally, on the lighter side of things — the all-star line-up for the “Stand Up to Cancer” telethon is almost finalized. | LINK

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Is the President waging an apparent one-man war as he still continues to gauge support for his nascent reform overhaul? As recently as a couple of days ago — as part of his weekly address — he renewed attacks on Insurance, noting that “For too long, we have been held hostage to an insurance industry that jacks up premiums and drops coverage as they please. But those days are finally coming to an end.”

Naturally, this message was directed to WellPoint, the California insurer which came under fire during the latter stages of the reform bill fight in Congress; it was accused of raising premiums to astronomical levels, establishing a fighting target and kicking off a newfound confidence in the President in getting his plan passed into law.

WellPoint’s CEO specifically responded to Obama and essentially told him to stop the attacks.

WellPoint Chief Executive Angela Braly fired back. In a letter Sunday addressed directly to Obama, she noted that policy changes were underway nationwide, and she called on him to stop his attacks on the industry. It will take cooperation between the industry and government to implement the new healthcare reform law, she said.

WellPoint also backed down and pledged its own internal investigations when recently accused of rescinding coverage to previously covered policyholders obtaining breast cancer treatments. HHS Secretary Sebelius and, now, Senator Diane Feinstein (D-CA), are urging for more discussions with the CEO and others to address this issue. Of course, this all begs the question — as insurance companies are supposed to be working with the President before the law requires them to specifically do so — can’t they all just get along? | LINK

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She’s a divorced 57 year-old female who was forced to step down from her job because of the debilitating side effects from the chemotherapy used to treat her breast cancer. Initially, from the time she was diagnosed, she was able to continue to work as a high powered executive. All of that came to a halt when she stopped working and subsequently had to sell her house in order to meet her co-pay and former employer health insurance costs. Now cancer free — but still needing expensive chemo — she survives on disability income and somehow manages to meet the constant out-of-pocket expenses she now has for medical services outside of her current physician network. Comparing herself to the Bionic Woman, the woman muses, “Sometimes you sit there and think: Am I really worth this?” | LINK | PDF of study here

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