ECRI reviews prostate cancer research
Filed under: Health data, Hot Health Headline, Studies, Tools, Uncategorized
The ECRI Institute’s new review of recent research on the utility of off-label prescription of Finasteride in the prevention of prostate cancer (PDF) presents research and clinical guidelines. Its bibliography and research review may be useful for anyone considering a follow-up to Gina Kolata’s recent New York Times piece on cancer prevention. Finasteride blocks an enzyme that aids the proliferation of prostate cancer cells. It’s used to reduce the size of enlarged prostates and, under the name Propecia, to treat male pattern baldness.
A large trial on finasteride, known as the Prostate Cancer Prevention Trial (PCPT), was published in 2003. The 18,882 men (asymptomatic, with normal PSA levels, 55 years of age or older) enrolled in the trial were randomly assigned to receive either finasteride or placebo for 7 years. … The authors of the trial reported that finasteride reduced the incidence of prostate cancer from 24.4% to 18.4%; however, the incidence of high-grade prostate cancers was 25.6% higher in the finasteride group than the placebo group. The clinical significance of these findings is unclear and has been widely debated.
The impact of prophylactic finasteride on long-term mortality and quality of life was not reported by the PCPT. Two models forecasting the impact of finasteride on mortality in participants in the PCPT were published. Grover et al. predicted that for every 1,000 men treated with finasteride, a total of 20 life-years (0.02 years per individual) would be saved, and Lotan et al. predicted that men treated with finasteride would, on average, gain 1.7 months of life.
The ECRI release was prompted by Kolata’s piece in The New York Times which questions why drugs that have been proven to prevent cancer are not being taken while many potentially harmful (and useless) supplements are. Kolata mentioned the Finasteride case in addition to similar examples involving breast cancer prevention drugs.
According to its Web site, the nonprofit ECRI Institute “dedicates itself to bringing the discipline of applied scientific research to healthcare to discover which medical procedures, devices, drugs, and processes are best to enable improved patient care.” The acronym ECRI has been adopted as the organization’s full name, but used to stand for “Emergency Care Research Institute.”
An ounce of prevention will cost you
Prevention is no panacea. If the country expects to keep people well by catching and treating disease early, better health won’t come cheap.
Stanford med school prof Abraham Verghese explains in a critique of Obama’s health plan in The Wall Street Journal. The gist: health reform won’t pay for itself.
Photo by digicla via Flickr
“Counting on the ’savings’ that will come as a result of investing in preventive care and investing in the electronic medical record among other things,” he writes, is “a dangerous and probably an incorrect projection.”
Sure, losing weight and exercising more don’t cost much. But Verghese says screening, testing and treating patients early is expensive. “Prevention is a good thing to do,” he says, “but why equate it with saving money when it won’t?”
The bottom line, Verghese writes, is that fundamental reform and an expansion of coverage can’t happen without cutting costs. That means drug prices, doctors’ fees and hospital charges are all in line to get whacked.
Related
In the Columbia Journalism Review, Trudy Lieberman, president of AHCJ’s board of directors, interviewed Rutgers researcher Louise Russell about the potential for preventive care to curb health care costs. Russell (bio page) said that, in many cases, preventive care may actually add to overall health care costs because, for such care to be effective, it needs to be employed on a large scale.
Russell says studies that claim savings based on prevention are not only calculating medical expense, but also figuring in potential future earnings of those whose lives are saved by prevention. She also encourages a stronger focus on more cost-effective preventive measures, like flu shots, over more expensive options like annual pap smears.
In the final third of the interview, Russell specifically addresses reporting on preventive care and provides guidance and recommendations.
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