Thanks to all the wonderful comments on the last blog. We obviously disagree on the Presidents version of good medicine. Looks like the majority of America disagrees with the President as well. As far as access is concerned the 44 million number bandied about by the left includes millions of illegal immigrants, those who refuse to buy healthcare, and those already eligible for medical assistance but for one reason or another are not assigned. I like how M. Hyman opines on the proper role for government. Where by the way does the Constitution create an entitlement for healthcare? That is debatable to say the least, and if Canada is such a wonderful provider of healthcare, why are they now re-instituting some level of private insurance and why do the wealthy of Canada come to the United States for they “elective” surgical procedures such as hip replacement, radical prostatectomy, and hernia repair. Just some questions to ponder as you get prepare to flame me again. Bring it on.
Treatment for prostate cancer is broadly divided into extirpative surgery, radiation therapy, cryosurgery, and watchful waiting. There are some other fringe treatments such as HIFU which are only being performed in very specific settings. Within each subsection there are a number of options. For example extirpative surgery implies the total removal of the prostate with reattachment of the bladder to the urethra. This can be done as an open procedure through the abdomen, as an open procedure underneath the scrotum, via laparoscopy and finally via the DaVinci Robot. All of these accomplish the same goal and all are valid, acceptable and successful methods of treating prostate cancer.
Radiation is another broad category which has a number of sub-treatments. External beam radiotherapy, prostate seed implantation, IMRT/IGRT, proton beam therapy, and finally Cyberknife Stereotactic Radiosurgery are the balance of the radiation options available to treat prostate cancer. Watchful waiting is often employed for those with a life expectancy of less than ten years. In Europe, watchful waiting is much more prevalent because of their medical systems.
Finally, cryosurgery or freezing of the prostate has a number of proponents as well. The morbid joke in urology is the butcher, the baker and the ice cube maker. The bottom line is that all of these treatment options are valid and have a similar degree of success. There likely will never be head to head studies, so all we can do is our best to compare apples to apples. For someone with low risk disease the chance of long term success is very good irrespective of type of treatment. For someone with high risk disease the probability of success is less and that statement holds true irrespective of treatment chosen. The real bottom line is for the patient to chose the surgeon with whom they are comfortable and the treatment with which they are comfortable. Don’t be afraid to get a second or third opinion and make sure that you are happy with your choice. I tell each of my patients that there are many ways to skin the same cat, just make sure that you choose what feels right for you.
Finally (really finally) to J.M. Reynolds whose response to my blog was rude and frankly inappropriate. What I write in this blog is my personal opinion. I am entitled to it. The Jewish Times does not censor me. They have allowed me to make sports, political, and medical commentary if that is what I want to do. If you don’t like what I have to say then you have a great option. Don’t read it. If you want to respond, feel free. But personal attack, semi-rude language and your obvious anger issues are as you say “sophomoric.” As I am sure your mommy told you many, many times, it doesn’t hurt you to say it nicely. And by the way - Go Ravens!!!!! Beat the Chargers!!!
Wishing everyone reading the JT a K’sivah Vchasima tova. All of K’lal Yisroel should be inscribed for a year of sweetness, health and prosperity.
Posted by .(JavaScript must be enabled to view this email address) on 09/18/09 at 10:52 AM | Comments (1)Comments
I live in Canada but come originally from Baltimore. I think all of you guys are going crazy. We (my family and I) are very happy about health care here. We do have a private insurance through my work, and it covers mostly detistry and medications. I am now over 65 so my medications (95% of them), are covered by the gov’t with a $8 co pay).
We have all been treated well, have never had a problem seeing a doctor and have, when necessary, been treated in a hospital.
There are some procedeures which may not be done here and people choose to go to the US, or are sent to the US to receive. If sent, it is covered by the government.
We only have 30 million people in the second largest country in the world and by sheer economy of scale, we do not have the vast medical facility of the US, of course.
None of this makes us communists or socialists.
I am a US citizen, and I am a Canadian citizen as of this year. We have lived in Canada for 16 years in two different cities.
We are not angry at anyone, and only wish you guys the best.
The truth is, due to health care costs, we will not be moving back to the US for retirement and are happy to stay where we are. As my wife and kids are younger, my medicare coverage will not cover them so staying here is a great choice.
A happy New Year to my family and friends in Baltimore!
Arthur Greenblatt
Posted by Arthur Greenblatt on 09/19/09 at 12:09 PM
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