USA Today column: Warren Buffett’s lost prostate cancer opportunity

My latest column was published this morning in USA Today: What’s right for Warren Buffett not right for every man.

I discuss Warren Buffett’s recent prostate cancer diagnosis, and whether he should have been screened in the first place: “Buffett’s coverage should have been an opportunity to educate the country that, for many, more conservative options would not only save them from harmful, unnecessary treatments, but also potentially reduce health costs.”

For those who’ve missed my national columns in the past month, here’s a recap.

CNN: Despite flaws, health care law is needed

CNN: Doctors and patients should talk more, test less

USA Today: Complex health choices require shared decisions

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  • Margalit Gur-Arie

    I think Mr. Buffet’s story raises different concerns. Here is a man who can afford the best medical care money can buy bar none. And here is this man undergoing testing and subsequently opting to receive treatment.
    There can be very little weight to an argument that both him and his physicians are not well informed or incapable of understanding the medical literature.
    So why are Mr. Buffet and his doctors choosing to do something that is not recommended for “every man”?
    Is it because the considerations in this case are centered solely on Mr. Buffet’s interest, while the considerations for “every man” are really about “all men”?
    Are we setting up a system where some men (Buffet, Cheney, etc.) are treated Harvard style where “every patient is the only patient”, while others are processed in bulk? If so, I think we should at least be honest about it.

  • maribelchavez

    Is there a way to poll all male urologists – practicing and retired – and find out how they deal with their own prostate glands?  Do they get the PSA test?  The ones diagnosed with cancer at various stages – what treatment option do they choose?  Whatever they do/would do is what they should recommend to their patients.

    • Violetta V

       Actually no. Just because Buffett and his doctor choose a particular course doesn’t mean it is the best for him much less for you. The statistics and studies are the same for everyone. Buffet is just as exposed to the media as anybody else and may well made a decision based on preconceived “earlier is better” notion rather than facts. Buffet is as human as you or I and has no more knowledge of statistics or studies. Buffet’s doctor cannot know what is not known to science and may just follow what Buffet wants. Or he may be a strong believer in testing or he may be afraid of a lawsuit. Just because he is a doctor who treats Buffet doesn’t make him infallible.

      1. Nobody – not Buffet’s doctor nor your doctor knows how Buffet’s cancer would behave or whether it is destined to spread in Buffet’s lifetime or whether his early diagnosis would make any difference. Based on the information that is avallable from the studies of PSA screening – it would not.
      2, Buffet may well end up impotent (which may not be an issue at his age) or incontinent from his treatment. Now if it may prolong his life you may be willing to pay a similar price, but if his cancer wouldn’t have been ever discovered in his lifetime? Given what studies show on PSA the latter is a lot more likely.

      Here is a thought – instead of looking for conspiracies why not just learn a little bit about the screening benefits and risks, studies, simpler statistical concepts like Number Needed to Screen, difference between absolute and relative risk reduction, lead time bias, overdiagnosis. Then you can read the available studies yourself and make up your own mind. As a start, try H Gilbert Welch book “Should I be tested for cancer” – the author is a professor in Dartmourth medical school, doctor, author of many papers published in peer reviewed journals. He isn’t arguing for- or against- screening, but he does explain the uncertainties, benefits, and risks in a way anybody can understand. Then you could make a truly informed decision instead of searching for conspiracies.

    • Violetta V

       Oops, I wanted to reply to the other comment but by accident my reply appeared under your comment. In terms of asking urologists – my guess is different urologists do different things, but you are assuming that urologists somehow know more than what studies showed – studies that actually COMPARED the number of people who died from prostate cancer in screened vs non-screened population – or that urologists are somehow better than people whose job it is to evaluate those studies for living.
      Urologists’ job is to diagnose and treat prostate cancer.They see a lot of patients but individual cases don’t mean much, plural of anecdotes isn’t data. But in terms of whether or not a particular test works or not, this is the job of epidemiologists not urologists.

      A urologist would see a case of a prostate cancer diagnosed by screening and person survives and the urologist would think “he lives because we diagnosed it early”. But in truth he doesn’t know: maybe the cancer wouldn’t have ever caused any problems if remained undetected, the urologist cannot know that because it is NOT KNOWN TO SCIENCE.  Because the urologists see ANECDOTAL cases, they may be prejudiced toward screening. Doesn’t mean the screening works.

  • davemills555

    Let’s face it, Republican Neanderthals have labeled as “death panels” any organized attempt for medical experts to come together to suggest the most effective treatments for specific illnesses and under what circumstances to use such treatments. It’s part of their well worn GOP rhetoric to repeal Obamacare, right? Anyone else bored to death, or is it just me? QUESTION: Doesn’t current wisdom rule out certain prostate cancer treatments for men over 81 years of age? Buffett is 81 years old. I’m told that prostate surgery is not advised for someone that old. Opps! Does that make me sound like a death panel member? 

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