A new study of an intensive and expensive form of prostate cancer therapy finds that doctors who stand to profit from the treatment are twice as likely to recommend it, even though there is no definitive evidence that it is better.
The treatment, known as intensity-modulated radiation therapy or IMRT, typically costs more than $31,000 while options costing about half that - or less - are available.
For instance, there is little evidence that it helps patients live longer, said the study's author, Jean Mitchell of Georgetown University in Washington, DC
Published in the New England Journal of Medicine, the study was financed by the American Society for Radiation Oncology, whose members have done IMRT therapy for years but have been losing business to the urologists who have bought their own IMRT machines and hired radiation specialists to operate them.
Federal law prohibits what is known as self-referral, when doctors send patients for tests or treatment from which the physician stands to gain financially, but makes an exception for "in house" services.
The urologists are taking advantage of a loophole in federal law that doesn't make it a conflict of interest for the doctors to benefit from such an arrangement, Mitchell said.
The society released a statement quoting its chairman, Dr. Colleen Lawton, as saying the "study provides clear, indisputable evidence that many men are receiving unnecessary radiation therapy for their prostate cancer due to self-referral."
The American Urological Association (AUA) responded by releasing a statement alleging the new study has "inherent biases and flawed methodologies" and questioning whether Mitchell "chose the control groups to arrive at results that were acceptable to the study's sponsors."
In July, when the U.S. Government Accountability Office (GAO) issued a report that reached a similar conclusion to that of the new study, the AUA and other urologist groups called that report "flawed and misleading," saying the GAO "provided no evidence that patients were being provided radiation therapy inappropriately" by groups that had acquired IMRT.
The current study is only the latest to show that doctors tend to order more tests and treatments or to select particular treatments over others when they have a financial interest in those services.
"I don't think this is any different than oncologists who might give a more expensive cancer drug because 6 percent of a more expensive drug brings more money into a practice than 6 percent of a cheaper drug," said Dr. Bruce Roth, an oncologist at Washington University School of Medicine in St. Louis who was not involved in the new research. "It's one more symptom of the underlying problem of reimbursing people for doing more stuff to patients."
However, he told Reuters Health that the current study is incomplete because, for example, it did not attempt to survey urologists to determine their motivation for more referrals to IMRT.
"The wrong thing to look at is total cost," he said. "It's no doubt that (IMRT) costs more, but it's probably better than conventional radiotherapy. But if you're going to make the hypothesis that the urologists are doing it for financial reasons, you should look at the flow of money back to the physicians, not just the costs, because this technology doesn't come free and all of that difference in dollars isn't flowing into the urologists' pockets."
Nearly 241,000 U.S. men are diagnosed with prostate cancer each year and the 10-year survival rate is 98 percent. The tumor often grows so slowly, a man will die from some other cause before his prostate tumor has a chance to kill him.
"You have to question (IMRT therapy) for men who are late 70s and into their 80s who are more likely to die from something other than their prostate cancer," Mitchell said. "Medicare is paying a lot of money for aggressive treatment of prostate cancer where it's basically not going to change anything i