Do Some Docs Have Vested Interest in Prescribing Radiation for Prostate Cancer?

Link here. Excerpt:

'Patients with prostate cancer may be encouraged to get radiation therapy by urologists who own the equipment, new research suggests.

According to study author Jean Mitchell, a professor of economics at Georgetown University, the use of expensive radiation treatments has increased substantially in practices that own the equipment.
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Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said urologists make only about $1,100 for surgery to remove the prostate, and watchful waiting involves only the limited cost of office visits and imaging.

Radiation treatment, however, can cost between $31,000 and $40,000, depending on where in the country patients are treated, Mitchell said.

"This is really showing that financial incentives really influence physician behavior," she said. "Patients have to wonder, 'Am I getting the treatment because it's really the best, or am I getting the treatment because my urologist is making money off of it?'" Mitchell said.
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D'Amico advises patients to ask if the medical evidence for their case supports radiation or surgery.

"The correct answer is either yes or no. If there is a choice, the patient should be told that the medical evidence is inconclusive. That's what they need to hear, because that's the truth. Most of the time, there is a choice," he said. "If they say the medical evidence in your case says it should be radiation, then the patient has to wonder whether or not [they're] getting it straight."

Moreover, D'Amico said patients should get a second opinion.

One critic of the study, Dr. Deepak Kapoor, president of the Large Urology Group Practice Association, said the study represents a political agenda and that doctors aren't pushing radiation therapy when they own the equipment.

He said the study misrepresents the actual data, and there is no real increase in the use of radiation therapy in practices that own their own equipment. In his view, the study is an attempt to persuade lawmakers to make radiation therapy for prostate cancer the sole province of radiation oncologists, which is why the association representing radiation oncologists funded the study.

But study author Mitchell painted a different picture.

"The urologists have tried to paint this as a turf battle, but in my view this is not their scope of practice," Mitchell said. "I know some urologists who are making $1 million a year, and $700,000 of it comes from their ancillary services -- radiation, pathology and imaging. Only $300,000 comes from what they were trained to do. And people wonder why health care is so expensive. This is one of the reasons. Everybody responds to financial incentives. Why should physicians be different? They're not."'