Health care reimbursement rates from insurance companies and Medicare drive many of our medical decisions in the United States. Call me a liberal, but I do believe that health care is a right, not a privilege and that financial decisions should NOT play a role in the decisions about what is best for patients.
However, it seems that capitalism in medicine continues to trump patient care. This is a fact in all cancer treatments, but is especially relevant when it comes to the treatment of prostate cancer. In the past, I have come across too many men who are started on a hormone blockade (ADT), to be left on it for years and years. Their quality of life disintegrates, but they are “strongly advised” to remain on ADT even after they reach a nadir of undetectable for an extended period. For some doctors, the thousands of dollars of profit that could be generated from administering ADT was just to attractive to pass by. So their patients are allowed to suffer, without any evidence that the therapy extends life, or even slows the progression of the prostate cancer!
Now, the issue of profit vs. best treatment for patients has encouraged doctors to surgically castrate men with prostate cancer instead of using drugs which are reversible. The reimbursement schedules for ADT has been consistently cut and so the profit from administering an injection has declined significantly. The ADT treatment that now yields the best economic return is now surgery and so many more men are being advised to have an orchiectomy.
I am not just blustering about this issue, it is not a figment of my imagination. There is nothing I can say to support this view that isn’t made extremely clear in the following abstract. I invite you do read it at: Economic Abuse of ADT.
Clearly, the use of medical androgen deprivation has fallen as orchiectomy rates rise after changes in reimbursement in the U.S. Medicare population. The decision the style of administration of either surgical or medical castration in the U.S. Medicare population is closely tied to the reimbursement available to treating physicians.
If your doctor suggests that you undergo an orchiectomy instead of going the route of medical castration stop your doctor and insist they explain why this is a better medical route for you to take. Unless they are able to convince you, beyond any doubt, insist that they provide you with a means for a reversible medical castration. If they refuse, find a new doctor.
Joel T Nowak MA, MSW