By Matthew Bui, MD, PhD
Everyone will agree that medical services are going through changes that could have a dramatic impact on how each of us receives health care. The Affordable Care Act will change the focus of health care delivery to “one-size fits all” medicine by using a statistical approach to medical decision making. Medical decisions will be based on statistics rather on the individual needs of the patient. In an effort to contain costs, government formed Task Forces will dictate if medical tests and treatments are reimbursed based on population studies rather than the appropriate needs of the patient. This broad generalized approach undermines the personalized care offered by the doctor-patient relationship.
Let us consider for example, the controversy over PSA screening. The US Health Task Force has made broad sweeping guidelines to condemn and reject prostate cancer screening. The guidelines appear to ignore the fact that prostate cancer is the leading cause of solid-organ cancer and the second leading cause of cancer death in American men. Despite these facts, the US Preventative Task Force recommends “many men are harmed as a result of prostate cancer screening and few, if any, benefit” and “recommends against screening for prostate cancer” (May, 2012). Urologists and medical oncologists were not enlisted in the committee that drafted these recommendations. The US Preventative Task Force also ignores the fact that large European population studies showed a 29% decreased risk of death from prostate cancer screening. Furthermore, the guidelines make no provisions for ethnic and genetic predispositions for prostate cancer. We know that African-American men are more likely to present earlier with prostate cancer that is also more aggressive. Similarly, a man with a first-degree relative with prostate cancer has a 3-4 fold increase of prostate cancer than the general population. Clearly, prostate cancer screening would be greatly benefit this specific population.
Personalized medicine should be the new “paradigm” of health care delivery. With newer genetic tests and better diagnostic tools, we are becoming smarter and more effective at treating specific diseases. However, this future may not be realized if our government intervention uproots the fundamentals of personalized care and treatment.