Bill McCollum has a plan. Rick Scott has a motto: "let's get to work???" What are we getting to work on?" Rick, do you have a plan, proposal, anything??? Maybe we will go with your skills and talent in the adventures of health care fraud...oh, not again. Yep, Rick says: "let's get to work." God knows you don't have any on the job work experience other than insurance fraud. I understand, I am a doctor. But I don't expect you to understand any of that. You are good at what you do and did...cheat , lie and self- benefit monetarily.
Hey, do you have problems sleeping at night??? Hum? I sleep well knowing that in over 30 years I have cared for patients without cheat, lie or self benefit . I have no issues. I love what I do.Do you love what you do/did? I was never employed by HCA to have done what you did---paid 1.7 billion in insurance fraud. You walked away with 300 million in bonus, and now you want to be elected governor of Florida??? Please, someone tell me this a joke... Please help us understand??? Vote for Rick Scott on a promise of "let's get started?" What are we getting started on??? Don't think so...........................
George M. Suarez, M.D.
Tuesday, July 20, 2010
Friday, July 16, 2010
IN CASE YOU MISSED IT
FOR IMMEDIATE RELEASE
JULY 15, 2010
CONTACT: Kristy Campbell
850-241-1885
kristy@billmccollum.com
IN CASE YOU MISSED IT: ST. PETERSBURG TIMES: Rick Scott’s Medicare fraud explanations are unsatisfactory
“Private wealth and public accountability”
St. Petersburg Times
Editorial
July 15, 2010
“Republican candidate for governor Rick Scott has shown in the past week he's not above exploiting his role as a hospital executive in a family's private medical issue to get votes — yet he still refuses to candidly answer questions about how his company ultimately paid a $1.7 billion fine for Medicare fraud. Democratic U.S. Senate candidate Jeff Greene likes to tout his experience as a ‘proven job creator’ as he accumulated a onetime $1.3 billion business empire — yet he still hasn't disclosed information on his finances that would give voters more time to independently evaluate his record. Private business executives have to recognize that running for public office requires more transparency, particularly when their opponents have long public records.
“Scott and Greene have earned vast sums of money in the private sector, but they are unknown and untested politically. They have become competitive in their respective races largely because they have spent millions of their own money on television ads and face weak candidates in primary elections. At least the public records are clear for Attorney General Bill McCollum, who faces Scott in the Republican primary for governor, and U.S. Rep. Kendrick Meek of Miami, who faces Greene in the Democratic Senate primary. Scott and Greene are far less transparent and unwilling to go beyond sound bites in describing their track records.
“Scott's posturing is particularly galling as he's been exploiting a family's medical crisis on the campaign trail to prove he is a ‘prolife leader.’ As CEO of Columbia/HCA he continued to fight a lawsuit filed by a Texas couple whose wishes for the treatment of their premature infant daughter were ignored. And his campaign and a third-party committee have spent at least $20 million on television ads, including one that references the fine his hospital company paid after a federal investigation for Medicare fraud. The ad includes Scott saying he is going to give the ‘unvarnished truth’ and that he ‘learned’ from the experience. He notes he was never interviewed by investigators or charged in the case.
“But unvarnished truth apparently has its limits. After the Miami Herald found at least one of Columbia/HCA's illegal practices — giving kickbacks to doctors who referred patients to the company's hospitals — traced back to the original Texas hospitals Scott ran, his campaign declined interview requests. It ultimately issued another oblique and wholly unsatisfactory statement. What lessons did Scott learn? What did he know? Scott won't elaborate. As governor would he insist on giving written statements rather than candid responses to the public?
“Then there is billionaire Greene, who sought a one-month delay June 18 in filing financial disclosure papers required under state election law. Greene claimed his attorney ‘hasn't been able to get it in yet.’ That Greene — who has the cash to hire a posse of professionals — didn't think it was a priority is disconcerting at best. Now it appears he's intent on making voters wait as long as possible by running out the clock.
“With less than six weeks before the Aug. 24 primary, and many ballots already in the mail, time is running short for Scott and Greene to open up to voters about their track records in private business. But they are going to have to offer more than slick television commercials or campaign stump speeches. If they are not comfortable with public disclosure of their private business dealings, they should not be running for public office.”
To view this piece, please visit the St. Petersburg Times online at http://www.tampabay.com/opinion/editorials/article1108979.ece. For more information, campaign news, and updates, visit www.BillMcCollum.com.
JULY 15, 2010
CONTACT: Kristy Campbell
850-241-1885
kristy@billmccollum.com
IN CASE YOU MISSED IT: ST. PETERSBURG TIMES: Rick Scott’s Medicare fraud explanations are unsatisfactory
“Private wealth and public accountability”
St. Petersburg Times
Editorial
July 15, 2010
“Republican candidate for governor Rick Scott has shown in the past week he's not above exploiting his role as a hospital executive in a family's private medical issue to get votes — yet he still refuses to candidly answer questions about how his company ultimately paid a $1.7 billion fine for Medicare fraud. Democratic U.S. Senate candidate Jeff Greene likes to tout his experience as a ‘proven job creator’ as he accumulated a onetime $1.3 billion business empire — yet he still hasn't disclosed information on his finances that would give voters more time to independently evaluate his record. Private business executives have to recognize that running for public office requires more transparency, particularly when their opponents have long public records.
“Scott and Greene have earned vast sums of money in the private sector, but they are unknown and untested politically. They have become competitive in their respective races largely because they have spent millions of their own money on television ads and face weak candidates in primary elections. At least the public records are clear for Attorney General Bill McCollum, who faces Scott in the Republican primary for governor, and U.S. Rep. Kendrick Meek of Miami, who faces Greene in the Democratic Senate primary. Scott and Greene are far less transparent and unwilling to go beyond sound bites in describing their track records.
“Scott's posturing is particularly galling as he's been exploiting a family's medical crisis on the campaign trail to prove he is a ‘prolife leader.’ As CEO of Columbia/HCA he continued to fight a lawsuit filed by a Texas couple whose wishes for the treatment of their premature infant daughter were ignored. And his campaign and a third-party committee have spent at least $20 million on television ads, including one that references the fine his hospital company paid after a federal investigation for Medicare fraud. The ad includes Scott saying he is going to give the ‘unvarnished truth’ and that he ‘learned’ from the experience. He notes he was never interviewed by investigators or charged in the case.
“But unvarnished truth apparently has its limits. After the Miami Herald found at least one of Columbia/HCA's illegal practices — giving kickbacks to doctors who referred patients to the company's hospitals — traced back to the original Texas hospitals Scott ran, his campaign declined interview requests. It ultimately issued another oblique and wholly unsatisfactory statement. What lessons did Scott learn? What did he know? Scott won't elaborate. As governor would he insist on giving written statements rather than candid responses to the public?
“Then there is billionaire Greene, who sought a one-month delay June 18 in filing financial disclosure papers required under state election law. Greene claimed his attorney ‘hasn't been able to get it in yet.’ That Greene — who has the cash to hire a posse of professionals — didn't think it was a priority is disconcerting at best. Now it appears he's intent on making voters wait as long as possible by running out the clock.
“With less than six weeks before the Aug. 24 primary, and many ballots already in the mail, time is running short for Scott and Greene to open up to voters about their track records in private business. But they are going to have to offer more than slick television commercials or campaign stump speeches. If they are not comfortable with public disclosure of their private business dealings, they should not be running for public office.”
To view this piece, please visit the St. Petersburg Times online at http://www.tampabay.com/opinion/editorials/article1108979.ece. For more information, campaign news, and updates, visit www.BillMcCollum.com.
Thursday, July 15, 2010
POSTED BY MATT WILLIAMS
Dear George,
The stakes in August’s Republican primary could not be higher. Florida faces a multitude of challenges, including a major jobs shortage, a budget crisis, and a need for a strong conservative leader in the Governor’s Mansion.
On one hand, Florida Republicans can elect Bill McCollum – leading our nation’s legal efforts to repeal President Obama’s health care laws, fighting for meaningful litigation reform to ease Florida’s doctor shortage and lower healthcare costs and working to implement an economic plan that will create 500,000 new jobs over six years.
As a Congressman and Attorney General, Florida’s healthcare community has had no better friend than Bill McCollum. His record on cutting government red tape and ending frivolous lawsuits prompted one of Florida’s most prominent trial lawyers to call Bill “the trial lawyers’ worst nightmare.”
On the other hand, Florida Republicans can put their hopes for our future in disgraced former Columbia CEO Rick Scott, who ran the company as it systematically defrauded the government in the largest Medicare fraud scheme in American history. Using the millions he made from defrauding taxpayers, Rick Scott has taken to the airwaves to mislead Floridians about his record.
As the campaign continues, we learn more about Rick Scott’s questionable background as a healthcare CEO. Here are the facts about Rick Scott’s tenure as Columbia CEO:
· While Rick Scott was CEO of Columbia the company would purchase inferior equipment to cut cost that could hinder doctors abilities to perform their duties:
o “Surgical gloves were thinner and more likely to break, alcohol sponges were smaller, and the valve on new chest drainage tubes substituted by Columbia did not indicate whether the device was turned on or off” (allnurses.com)
o “’Gloves rip easily,’ complained hospital workers in Florida. In California, some nurses protested “filthy conditions” and being “stretched to the limit as the hospital slashed the ratio of nurses to patients” “I sometimes had to watch 72 patients heart monitors at a time,” one nurse reported. “I was told, either do it, or there’s the door.” In Indianapolis nurses complained to state authorities that babies in the neonatal unit were left unattended for as long as three hours.” (healthbeatblog.com: Who is Richard Scott and why is he saying these things about healthcare reform?)
· Richard Scott and Columbia attempted to bribe doctors:
o In 1997, in El Paso, Texas, a Federal jury found that Columbia, “personally” authorized by Rick Scott, had secretly paid doctor Ambrose Aboud $152,000 for "outstanding expenses" that he had not incurred as part of an unlawful conspiracy to defraud the business partner. (Kurt Eichenwald, New York Times: A Health Care Giant's Secret Payments Taint a Texas Deal, March 29, 1997)
o Agents with the Federal Bureau of Investigation wrote in a memorandum that executives from hospitals that Columbia was attempting to buy reported that Columbia offered them “perquisites and promises of jobs” and other inducements as bribes to affect their decisions on whether to sell to Columbia. This includes John Geanes, a former administrator of South Miami Hospital who stated before a grand jury that he was approached by several Columbia officials including Rick Scott.( NEW YORK TIMES: HEALTH CARE'S GIANT: Powerhouse Under Scrutiny -- A special report.; Biggest Hospital Operator Attracts Federal Inquiries, March 28, 1997, by Martin Gottlieb, Kurt Eichenwald and Josh Barbanel)
· Rick Scott and Columbia cut doctors that were not bringing in maximum profit, at the expense of patient care
o “The profit pressure that left Lawrence County, which is 71 miles southwest of Nashville, without an obstetrician also helped make Columbia the target of federal investigators. And it began affecting patient care immediately after Columbia's 1994 takeover of Hospital Corp. of America, current and former hospital employees say.”
o “Critics point to one incident in 1994, when Columbia cut back on services at a money-losing hospital in Destin, Fla. A man injured in a boating accident was left pleading from his stretcher for emergency room staff to treat him, as yellow tape blocked entry to the ER door.” (John Hendren, Hospital chain's profits took toll on patient care, employees say” John Hendren, AP, Hospital chain's profits took toll on patient care, employees say, 9/7/1997)
With the Florida Medical Association’s recent announcement to unanimously endorse Attorney General Bill McCollum for Governor, we feel the momentum heading into August is on our side. But to ensure it remains that way and to keep Rick Scott and his fraudulent business tactics out of the Governor’s Office, we need your support. Your maximum donation of $500 per person of $1,000 per household will ensure Florida’s medical community will have a strong advocate in the Governor’s Mansion and help us educate Florida Republicans about Rick Scott’s real record as CEO of Columbia. To keep up with Rick Scott’s massive spending, we need your support.
Matt Williams
Campaign Manager
McCollum for Governor
P.S. Support our campaign by clicking here.
The stakes in August’s Republican primary could not be higher. Florida faces a multitude of challenges, including a major jobs shortage, a budget crisis, and a need for a strong conservative leader in the Governor’s Mansion.
On one hand, Florida Republicans can elect Bill McCollum – leading our nation’s legal efforts to repeal President Obama’s health care laws, fighting for meaningful litigation reform to ease Florida’s doctor shortage and lower healthcare costs and working to implement an economic plan that will create 500,000 new jobs over six years.
As a Congressman and Attorney General, Florida’s healthcare community has had no better friend than Bill McCollum. His record on cutting government red tape and ending frivolous lawsuits prompted one of Florida’s most prominent trial lawyers to call Bill “the trial lawyers’ worst nightmare.”
On the other hand, Florida Republicans can put their hopes for our future in disgraced former Columbia CEO Rick Scott, who ran the company as it systematically defrauded the government in the largest Medicare fraud scheme in American history. Using the millions he made from defrauding taxpayers, Rick Scott has taken to the airwaves to mislead Floridians about his record.
As the campaign continues, we learn more about Rick Scott’s questionable background as a healthcare CEO. Here are the facts about Rick Scott’s tenure as Columbia CEO:
· While Rick Scott was CEO of Columbia the company would purchase inferior equipment to cut cost that could hinder doctors abilities to perform their duties:
o “Surgical gloves were thinner and more likely to break, alcohol sponges were smaller, and the valve on new chest drainage tubes substituted by Columbia did not indicate whether the device was turned on or off” (allnurses.com)
o “’Gloves rip easily,’ complained hospital workers in Florida. In California, some nurses protested “filthy conditions” and being “stretched to the limit as the hospital slashed the ratio of nurses to patients” “I sometimes had to watch 72 patients heart monitors at a time,” one nurse reported. “I was told, either do it, or there’s the door.” In Indianapolis nurses complained to state authorities that babies in the neonatal unit were left unattended for as long as three hours.” (healthbeatblog.com: Who is Richard Scott and why is he saying these things about healthcare reform?)
· Richard Scott and Columbia attempted to bribe doctors:
o In 1997, in El Paso, Texas, a Federal jury found that Columbia, “personally” authorized by Rick Scott, had secretly paid doctor Ambrose Aboud $152,000 for "outstanding expenses" that he had not incurred as part of an unlawful conspiracy to defraud the business partner. (Kurt Eichenwald, New York Times: A Health Care Giant's Secret Payments Taint a Texas Deal, March 29, 1997)
o Agents with the Federal Bureau of Investigation wrote in a memorandum that executives from hospitals that Columbia was attempting to buy reported that Columbia offered them “perquisites and promises of jobs” and other inducements as bribes to affect their decisions on whether to sell to Columbia. This includes John Geanes, a former administrator of South Miami Hospital who stated before a grand jury that he was approached by several Columbia officials including Rick Scott.( NEW YORK TIMES: HEALTH CARE'S GIANT: Powerhouse Under Scrutiny -- A special report.; Biggest Hospital Operator Attracts Federal Inquiries, March 28, 1997, by Martin Gottlieb, Kurt Eichenwald and Josh Barbanel)
· Rick Scott and Columbia cut doctors that were not bringing in maximum profit, at the expense of patient care
o “The profit pressure that left Lawrence County, which is 71 miles southwest of Nashville, without an obstetrician also helped make Columbia the target of federal investigators. And it began affecting patient care immediately after Columbia's 1994 takeover of Hospital Corp. of America, current and former hospital employees say.”
o “Critics point to one incident in 1994, when Columbia cut back on services at a money-losing hospital in Destin, Fla. A man injured in a boating accident was left pleading from his stretcher for emergency room staff to treat him, as yellow tape blocked entry to the ER door.” (John Hendren, Hospital chain's profits took toll on patient care, employees say” John Hendren, AP, Hospital chain's profits took toll on patient care, employees say, 9/7/1997)
With the Florida Medical Association’s recent announcement to unanimously endorse Attorney General Bill McCollum for Governor, we feel the momentum heading into August is on our side. But to ensure it remains that way and to keep Rick Scott and his fraudulent business tactics out of the Governor’s Office, we need your support. Your maximum donation of $500 per person of $1,000 per household will ensure Florida’s medical community will have a strong advocate in the Governor’s Mansion and help us educate Florida Republicans about Rick Scott’s real record as CEO of Columbia. To keep up with Rick Scott’s massive spending, we need your support.
Matt Williams
Campaign Manager
McCollum for Governor
P.S. Support our campaign by clicking here.
NEW POST BY DR. GEORGE SUAREZ
Just when you thought we heard it all on Rick Scott's mafia approach to business and politics, here is more. He simply wants to buy his way into the Governor's mansion, into Floridian and will stop at nothing. He even regressed on his own promise to obey the state campaign finance law – the same law Rick Scott agreed to follow when he filed to run for Governor of the State of Florida. But with the change of events that have revealed who the true Rick Scott is, he now tried desperately to break away from campaign finance laws, spend more money and try to buy his way to becomes Florida's Governor. That is the truth on Rick Scott.
Yep, a zebra does not change it's stripes, nor a leopard his spots. We got Rick Scott's stripes and spots. They are called untruthful, dishonest, liar and cheat. Plus a lack of moral accountability. This guy really thinks he can be governor of Florida by buying his way? The same way he bought himself out of insurance fraud charges with 1.7 billion dollar fine?
George M. Suarez, M.D.
Yep, a zebra does not change it's stripes, nor a leopard his spots. We got Rick Scott's stripes and spots. They are called untruthful, dishonest, liar and cheat. Plus a lack of moral accountability. This guy really thinks he can be governor of Florida by buying his way? The same way he bought himself out of insurance fraud charges with 1.7 billion dollar fine?
George M. Suarez, M.D.
Monday, July 12, 2010
LATEST NEWS
RICK SCOTT SUES THE STATE DESPITE EARLIER PLEDGE TO ABIDE BY CAMPAIGN SPENDING CAPS
Tallahassee, FL – Today, McCollum for Governor Campaign Matt Williams issued the following statement regarding Bill McCollum’s motion to intervene in the case of Rick Scott v. the Florida Department of State:
“On the day Rick Scott filed to run for Governor, he pledged to abide by campaign spending caps currently in state law. Now that he is failing to win over voters, despite the millions he is personally hemorrhaging into his campaign to pay for false and negative attacks against Bill McCollum, he wants to change the rules of the game. There Rick Scott goes again, saying one thing and doing another.
“On June 17, Rick Scott promised to stay under the $24.9 million limit on spending and less than a month later he now says he plans to exceed that. Now he’s using money he ripped off from taxpayers to sue the state of Florida, in a greedy and dishonest attempt to avoid the repercussions of his decision.
“Today, Bill McCollum filed a motion seeking to join the case in support of upholding state law. Given that Rick Scott’s lawsuit mentions him directly, it is only appropriate for Attorney General McCollum to join this case to ensure his position is adequately represented.”
“Thankfully, Florida voters are becoming increasingly disgusted with a greedy and dishonest insider who will say and spend anything to avoid his record – from profiting off illegal immigrants to making millions off President Obama’s $780 billion stimulus boondoggle.”
To view video of Rick Scott pledging to abide by campaign spending caps, visit: http://www.youtube.com/watch?v=VGXFdP6oOFU.
To access the motion, please click here: http://billmccollum.com/press-release/2010/07/12/rick-scott-sueing-the-state-despite-earlier-pledge-to-abide-by-campaign-spending-caps/.
For more information, campaign news, and updates, visit www.BillMcCollum.com.
# # #
Political advertisement paid for and approved by Bill McCollum, Republican, for Governor.
The purchase of a ticket for, or a contribution to, the campaign fundraiser is a contribution
to the campaign of Bill McCollum. Contributions are not deductible for federal income tax purposes.
PO Box 10829, Tallahassee, FL 32302-2829 | P: 850-241-1885
Tallahassee, FL – Today, McCollum for Governor Campaign Matt Williams issued the following statement regarding Bill McCollum’s motion to intervene in the case of Rick Scott v. the Florida Department of State:
“On the day Rick Scott filed to run for Governor, he pledged to abide by campaign spending caps currently in state law. Now that he is failing to win over voters, despite the millions he is personally hemorrhaging into his campaign to pay for false and negative attacks against Bill McCollum, he wants to change the rules of the game. There Rick Scott goes again, saying one thing and doing another.
“On June 17, Rick Scott promised to stay under the $24.9 million limit on spending and less than a month later he now says he plans to exceed that. Now he’s using money he ripped off from taxpayers to sue the state of Florida, in a greedy and dishonest attempt to avoid the repercussions of his decision.
“Today, Bill McCollum filed a motion seeking to join the case in support of upholding state law. Given that Rick Scott’s lawsuit mentions him directly, it is only appropriate for Attorney General McCollum to join this case to ensure his position is adequately represented.”
“Thankfully, Florida voters are becoming increasingly disgusted with a greedy and dishonest insider who will say and spend anything to avoid his record – from profiting off illegal immigrants to making millions off President Obama’s $780 billion stimulus boondoggle.”
To view video of Rick Scott pledging to abide by campaign spending caps, visit: http://www.youtube.com/watch?v=VGXFdP6oOFU.
To access the motion, please click here: http://billmccollum.com/press-release/2010/07/12/rick-scott-sueing-the-state-despite-earlier-pledge-to-abide-by-campaign-spending-caps/.
For more information, campaign news, and updates, visit www.BillMcCollum.com.
# # #
Political advertisement paid for and approved by Bill McCollum, Republican, for Governor.
The purchase of a ticket for, or a contribution to, the campaign fundraiser is a contribution
to the campaign of Bill McCollum. Contributions are not deductible for federal income tax purposes.
PO Box 10829, Tallahassee, FL 32302-2829 | P: 850-241-1885
Thursday, July 8, 2010
THE LANCET - ONCOLOGY
The Lancet Oncology, Early Online Publication, 1 July 2010doi:10.1016/S1470-2045(10)70146-7Cite or Link Using DOIMortality results from the Göteborg randomised population-based prostate-cancer screening trial
Original Text
Prof Jonas Hugosson MD a , Sigrid Carlsson MD a, Gunnar Aus MD a, Svante Bergdahl MD a, Ali Khatami MD a, Pär Lodding MD a, Carl-Gustaf Pihl MD c, Johan Stranne MD a, Erik Holmberg PhD b, Hans Lilja MD d e
Summary
Background
Prostate cancer is one of the leading causes of death from malignant disease among men in the developed world. One strategy to decrease the risk of death from this disease is screening with prostate-specific antigen (PSA); however, the extent of benefit and harm with such screening is under continuous debate.
Methods
In December, 1994, 20 000 men born between 1930 and 1944, randomly sampled from the population register, were randomised by computer in a 1:1 ratio to either a screening group invited for PSA testing every 2 years (n=10 000) or to a control group not invited (n=10 000). Men in the screening group were invited up to the upper age limit (median 69, range 67—71 years) and only men with raised PSA concentrations were offered additional tests such as digital rectal examination and prostate biopsies. The primary endpoint was prostate-cancer specific mortality, analysed according to the intention-to-screen principle. The study is ongoing, with men who have not reached the upper age limit invited for PSA testing. This is the first planned report on cumulative prostate-cancer incidence and mortality calculated up to Dec 31, 2008. This study is registered as an International Standard Randomised Controlled TrialISRCTN54449243.
Findings
In each group, 48 men were excluded from the analysis because of death or emigration before the randomisation date, or prevalent prostate cancer. In men randomised to screening, 7578 (76%) of 9952 attended at least once. During a median follow-up of 14 years, 1138 men in the screening group and 718 in the control group were diagnosed with prostate cancer, resulting in a cumulative prostate-cancer incidence of 12·7% in the screening group and 8·2% in the control group (hazard ratio 1·64; 95% CI 1·50—1·80; p<0·0001). The absolute cumulative risk reduction of death from prostate cancer at 14 years was 0·40% (95% CI 0·17—0·64), from 0·90% in the control group to 0·50% in the screening group. The rate ratio for death from prostate cancer was 0·56 (95% CI 0·39—0·82; p=0·002) in the screening compared with the control group. The rate ratio of death from prostate cancer for attendees compared with the control group was 0·44 (95% CI 0·28—0·68; p=0·0002). Overall, 293 (95% CI 177—799) men needed to be invited for screening and 12 to be diagnosed to prevent one prostate cancer death.
Interpretation
This study shows that prostate cancer mortality was reduced almost by half over 14 years. However, the risk of over-diagnosis is substantial and the number needed to treat is at least as high as in breast-cancer screening programmes. The benefit of prostate-cancer screening compares favourably to other cancer screening programs.
Funding
The Swedish Cancer Society, the Swedish Research Council, and the National Cancer Institute
Original Text
Prof Jonas Hugosson MD a , Sigrid Carlsson MD a, Gunnar Aus MD a, Svante Bergdahl MD a, Ali Khatami MD a, Pär Lodding MD a, Carl-Gustaf Pihl MD c, Johan Stranne MD a, Erik Holmberg PhD b, Hans Lilja MD d e
Summary
Background
Prostate cancer is one of the leading causes of death from malignant disease among men in the developed world. One strategy to decrease the risk of death from this disease is screening with prostate-specific antigen (PSA); however, the extent of benefit and harm with such screening is under continuous debate.
Methods
In December, 1994, 20 000 men born between 1930 and 1944, randomly sampled from the population register, were randomised by computer in a 1:1 ratio to either a screening group invited for PSA testing every 2 years (n=10 000) or to a control group not invited (n=10 000). Men in the screening group were invited up to the upper age limit (median 69, range 67—71 years) and only men with raised PSA concentrations were offered additional tests such as digital rectal examination and prostate biopsies. The primary endpoint was prostate-cancer specific mortality, analysed according to the intention-to-screen principle. The study is ongoing, with men who have not reached the upper age limit invited for PSA testing. This is the first planned report on cumulative prostate-cancer incidence and mortality calculated up to Dec 31, 2008. This study is registered as an International Standard Randomised Controlled TrialISRCTN54449243.
Findings
In each group, 48 men were excluded from the analysis because of death or emigration before the randomisation date, or prevalent prostate cancer. In men randomised to screening, 7578 (76%) of 9952 attended at least once. During a median follow-up of 14 years, 1138 men in the screening group and 718 in the control group were diagnosed with prostate cancer, resulting in a cumulative prostate-cancer incidence of 12·7% in the screening group and 8·2% in the control group (hazard ratio 1·64; 95% CI 1·50—1·80; p<0·0001). The absolute cumulative risk reduction of death from prostate cancer at 14 years was 0·40% (95% CI 0·17—0·64), from 0·90% in the control group to 0·50% in the screening group. The rate ratio for death from prostate cancer was 0·56 (95% CI 0·39—0·82; p=0·002) in the screening compared with the control group. The rate ratio of death from prostate cancer for attendees compared with the control group was 0·44 (95% CI 0·28—0·68; p=0·0002). Overall, 293 (95% CI 177—799) men needed to be invited for screening and 12 to be diagnosed to prevent one prostate cancer death.
Interpretation
This study shows that prostate cancer mortality was reduced almost by half over 14 years. However, the risk of over-diagnosis is substantial and the number needed to treat is at least as high as in breast-cancer screening programmes. The benefit of prostate-cancer screening compares favourably to other cancer screening programs.
Funding
The Swedish Cancer Society, the Swedish Research Council, and the National Cancer Institute
Tuesday, July 6, 2010
THE ADVANTAGES OF HIFU
Great article in the WSJ on the University of Gothenburg's findings on the value of PSA to be more sensitive that in screening for other types of common cancers, such as breast and colon cancer. The facts are: 1) PSA is the most precise and sensitive of all tumor markers. 2) Prostate cancer is the most common cancer in men. 3) Prostate cancer is the second most common cancer in men. 4) If detected early, it's curable. The conclusion of the Gothenburg research: PSA screening and treatment can reduce the risk of death from prostate cancer by as much as 50%.
The real challenge for men is when it comes to choosing a treatment. There lies the real issue, in that among physician worldwide, there is no general consensus as to the optimal treatment. Instead, treatment recommendations are a bias of the specialty and the training of the treating physician: surgeons will recommend surgery, and radiation oncologist radiation. As the saying goes: "to hammer everything looks like a nail." Likewise, is the bias when it comes to treating prostate cancer. The latest craze is the Robotic prostatectomy! However, most recent evidence shows that Robotic prostatectomy has a higher risk of recurrence and no better clinical outcomes in the incidence of impotence and urinary incontinence. After all, it's still the same human hands directing the Robotic instruments.
Other unique characteristic about prostate cancer is that the standard treatments available come with a high risks of complications. Particularly in quality of life matters such as greater than 50% incidence of impotence and 10-20 % risk of urinary incontinence associated with surgical removal of the prostate. There are similar risks with radiation. Plus a high risk of developing a secondary cancer from the exposure to the radiation. These issues are so concerning to men, that they often elect on "watchful waiting" or "active surveillance" at the risk of progression of cancer and metastasis... another unique characteristic of prostate cancer. I certainly know of no malignancy where a patient would consider opting for no treatment at the risk of death.
For the past 7 years I have offered High Intensity Focused Ultrasound or HIFU to patients with localized prostate cancer. The technology has been approved in Europe and other countries since 1998, and currently is approved worldwide, except in the U.S. However, American urologist have embraced the procedure and travel with their patients to treat them in countries where it is approved. Another unique characteristic of prostate cancer: American urologist and their patients are willing to travel outside the U.S. in order to perform and receive this very advanced futuristic treatment. But this is not really unique, as Americans are familiar with seeking health care outside the U.S. while procedures and medications are pending FDA approval.
The principle advantage to HIFU is that there are less risk of impotence and incontinence: the two most dreaded potential complication feared by men. Clinical efficacy of HIFU in recent years has proven post treatment PSA (PSA Nadir) of the same range as surgical removal or radiation therapy. To the skeptics, the initial impression is that the whole thing is too good to be true. But it is that good, in efficacy of treatment, and less risk of complications. Otherwise, the FDA would not have allowed the clinical trials to progress from Phase I and II, to current phase III. Another interesting bit of information: None of the "standard" treatments available for treating prostate cancer was ever FDA approved, nor did any of them undergo any type of clinical trial. Instead they were "grand- fathered" as treatments that were used prior to more rigorous FDA regulation came into place.
The Gothenburg study will undoubtedly influence the application of PSA screening by both physician's use and patient's request. Unfortunate, this will lead to the potential risk of overtreatment and increase number of patients at risk of compromised quality of life. The American Cancer Society reports approximately 250,000 new cases of prostate cancer per year. Increase screening, as well longer living population, will lead to more patients diagnosed with prostate cancer. Potentially doubling the number of newly diagnosed patients per year. As well as creating a huge economic burden, if not a crisis in the cost of healthcare. The cost of treatments does vary, with radiation being the most costly. The cost of a HIFU treatment is significantly less than all standard treatments. In Addition, as an outpatient procedure, it allows the patient to return to work and other routine activities the day after treatment is a plus for patient convenience as well as lost of revenue and productivity.
The advantages of HIFU have been recognized by many health insurance companies in the U.S., to the point that many of them are pre-approving payment or reimbursing patient afterwards. Interestingly, Tricare for Life, the healthcare carrier for retired and active federal government employees has pre- approved payment for HIFU with the Sonoblade-500 device. Another challenging question: it is approved by the healthcare provider to federal government employees, but not FDA approved? Yet, I am confident that it will soon be available to Americans. But in the mean time, they can travel to almost anywhere in the world for HIFU treatments. HIFU Clinical trials are being performed in some of the most prestige's medical centers in the country. Including The Walter Reed hospital, where American soldiers and veterans receive unequaled best medical care.
How likely is HIFU to get FDA approval? Having personally performed over 2,000 cases, and trained hundreds of urologist from around the world, I am confident that HIFU will be approved. It just a matter of the time it takes to complete the trials. What impact will HIFU have as a treatment option for prostate cancer? Several Biomedical Wall Street analysts and industry newsletters predict a 91% compounded yearly growth over the next five years, with HIFU becoming the most common treatment for prostate cancer by 2015. I never imagined a four letter word would impact healthcare so positively and so powerfully. But it has happened before. I remember the huge incisions we made to remove tiny kidney stone, the ensuing pain and days of recovery. Sometimes resecting ribs and injuring adjacent tissue and whole organs. Then there came another four letter word: ESWL, (extracorporael shock wave lithotripsy) and no more opened surgery for kidney stones. ESWL was approved by the FDA in 1884. Interestingly, the science and technology of ESWL is the same as for HIFU. It's called piezoelectric energy. How big is HIFU as an available treatment for the most common cancer in men, and the second most common cause of death related to cancer versus the impact of ESWL? Kidney stone affects a small number of Americans, and patients typically don't die from kidney stones.
George M. Suarez, M.D. F.A.C.S.
Board Certified Urologist
305-595-0199
9195 Sunset Dr. Suite 110
Miami, Florida
www.hifumedicalexpert.com
The real challenge for men is when it comes to choosing a treatment. There lies the real issue, in that among physician worldwide, there is no general consensus as to the optimal treatment. Instead, treatment recommendations are a bias of the specialty and the training of the treating physician: surgeons will recommend surgery, and radiation oncologist radiation. As the saying goes: "to hammer everything looks like a nail." Likewise, is the bias when it comes to treating prostate cancer. The latest craze is the Robotic prostatectomy! However, most recent evidence shows that Robotic prostatectomy has a higher risk of recurrence and no better clinical outcomes in the incidence of impotence and urinary incontinence. After all, it's still the same human hands directing the Robotic instruments.
Other unique characteristic about prostate cancer is that the standard treatments available come with a high risks of complications. Particularly in quality of life matters such as greater than 50% incidence of impotence and 10-20 % risk of urinary incontinence associated with surgical removal of the prostate. There are similar risks with radiation. Plus a high risk of developing a secondary cancer from the exposure to the radiation. These issues are so concerning to men, that they often elect on "watchful waiting" or "active surveillance" at the risk of progression of cancer and metastasis... another unique characteristic of prostate cancer. I certainly know of no malignancy where a patient would consider opting for no treatment at the risk of death.
For the past 7 years I have offered High Intensity Focused Ultrasound or HIFU to patients with localized prostate cancer. The technology has been approved in Europe and other countries since 1998, and currently is approved worldwide, except in the U.S. However, American urologist have embraced the procedure and travel with their patients to treat them in countries where it is approved. Another unique characteristic of prostate cancer: American urologist and their patients are willing to travel outside the U.S. in order to perform and receive this very advanced futuristic treatment. But this is not really unique, as Americans are familiar with seeking health care outside the U.S. while procedures and medications are pending FDA approval.
The principle advantage to HIFU is that there are less risk of impotence and incontinence: the two most dreaded potential complication feared by men. Clinical efficacy of HIFU in recent years has proven post treatment PSA (PSA Nadir) of the same range as surgical removal or radiation therapy. To the skeptics, the initial impression is that the whole thing is too good to be true. But it is that good, in efficacy of treatment, and less risk of complications. Otherwise, the FDA would not have allowed the clinical trials to progress from Phase I and II, to current phase III. Another interesting bit of information: None of the "standard" treatments available for treating prostate cancer was ever FDA approved, nor did any of them undergo any type of clinical trial. Instead they were "grand- fathered" as treatments that were used prior to more rigorous FDA regulation came into place.
The Gothenburg study will undoubtedly influence the application of PSA screening by both physician's use and patient's request. Unfortunate, this will lead to the potential risk of overtreatment and increase number of patients at risk of compromised quality of life. The American Cancer Society reports approximately 250,000 new cases of prostate cancer per year. Increase screening, as well longer living population, will lead to more patients diagnosed with prostate cancer. Potentially doubling the number of newly diagnosed patients per year. As well as creating a huge economic burden, if not a crisis in the cost of healthcare. The cost of treatments does vary, with radiation being the most costly. The cost of a HIFU treatment is significantly less than all standard treatments. In Addition, as an outpatient procedure, it allows the patient to return to work and other routine activities the day after treatment is a plus for patient convenience as well as lost of revenue and productivity.
The advantages of HIFU have been recognized by many health insurance companies in the U.S., to the point that many of them are pre-approving payment or reimbursing patient afterwards. Interestingly, Tricare for Life, the healthcare carrier for retired and active federal government employees has pre- approved payment for HIFU with the Sonoblade-500 device. Another challenging question: it is approved by the healthcare provider to federal government employees, but not FDA approved? Yet, I am confident that it will soon be available to Americans. But in the mean time, they can travel to almost anywhere in the world for HIFU treatments. HIFU Clinical trials are being performed in some of the most prestige's medical centers in the country. Including The Walter Reed hospital, where American soldiers and veterans receive unequaled best medical care.
How likely is HIFU to get FDA approval? Having personally performed over 2,000 cases, and trained hundreds of urologist from around the world, I am confident that HIFU will be approved. It just a matter of the time it takes to complete the trials. What impact will HIFU have as a treatment option for prostate cancer? Several Biomedical Wall Street analysts and industry newsletters predict a 91% compounded yearly growth over the next five years, with HIFU becoming the most common treatment for prostate cancer by 2015. I never imagined a four letter word would impact healthcare so positively and so powerfully. But it has happened before. I remember the huge incisions we made to remove tiny kidney stone, the ensuing pain and days of recovery. Sometimes resecting ribs and injuring adjacent tissue and whole organs. Then there came another four letter word: ESWL, (extracorporael shock wave lithotripsy) and no more opened surgery for kidney stones. ESWL was approved by the FDA in 1884. Interestingly, the science and technology of ESWL is the same as for HIFU. It's called piezoelectric energy. How big is HIFU as an available treatment for the most common cancer in men, and the second most common cause of death related to cancer versus the impact of ESWL? Kidney stone affects a small number of Americans, and patients typically don't die from kidney stones.
George M. Suarez, M.D. F.A.C.S.
Board Certified Urologist
305-595-0199
9195 Sunset Dr. Suite 110
Miami, Florida
www.hifumedicalexpert.com
DRAMATIC HOPE AND CHANGE IN NOVEMBER
Governors of 35 states have already filed suit against the Federal
Government for imposing unlawful burdens upon them. It only takes 38 (of
the 50) States to convene a Constitutional Convention.
This will take less than thirty seconds to read. Please pass it on.
For too long we have been too complacent about the workings of Congress.
Many citizens had no idea that members of Congress could retire with the
same pay after only one term, that they didn't pay into Social Security,
that they specifically exempted themselves from many of the laws they have
passed (such as being exempt from any fear of prosecution for sexual
harassment) while ordinary citizens must live under those laws. The latest
is to exempt themselves from the Healthcare Reform that is being
considered...in all of its forms. Somehow, that doesn't seem logical. We
do not have an elite that is above the law. I truly don't care if they are
Democrat, Republican, Independent or whatever. The self-serving must stop.
This is a good way to do that. It is an idea whose time has come.
Have each person contact a minimum of twenty people on their Address list;
in turn ask each of those to do likewise.
In three days, most people in The United States of America will have the
message. This is one proposal that really should be passed around.
Proposed 28th Amendment to the United States Constitution:
"Congress shall make no law that applies to the citizens of the United
States that does not apply equally to the Senators and/or Representatives;
and, Congress shall make no law that applies to the Senators and/or
Representatives that does not apply equally to the citizens of the United
States ."
You are one of my 20.
Don't forget to "Take out the trash this November
Government for imposing unlawful burdens upon them. It only takes 38 (of
the 50) States to convene a Constitutional Convention.
This will take less than thirty seconds to read. Please pass it on.
For too long we have been too complacent about the workings of Congress.
Many citizens had no idea that members of Congress could retire with the
same pay after only one term, that they didn't pay into Social Security,
that they specifically exempted themselves from many of the laws they have
passed (such as being exempt from any fear of prosecution for sexual
harassment) while ordinary citizens must live under those laws. The latest
is to exempt themselves from the Healthcare Reform that is being
considered...in all of its forms. Somehow, that doesn't seem logical. We
do not have an elite that is above the law. I truly don't care if they are
Democrat, Republican, Independent or whatever. The self-serving must stop.
This is a good way to do that. It is an idea whose time has come.
Have each person contact a minimum of twenty people on their Address list;
in turn ask each of those to do likewise.
In three days, most people in The United States of America will have the
message. This is one proposal that really should be passed around.
Proposed 28th Amendment to the United States Constitution:
"Congress shall make no law that applies to the citizens of the United
States that does not apply equally to the Senators and/or Representatives;
and, Congress shall make no law that applies to the Senators and/or
Representatives that does not apply equally to the citizens of the United
States ."
You are one of my 20.
Don't forget to "Take out the trash this November
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