Here's Marc's piece...
THE WORLD'S TOP MEDICINE
By MARC SIEGEL
October 5, 2007 -- CRITICS of the U.S. health-care system point to the 100,000 or so Americans who go overseas for treatment each year, typically citing lower costs. Fair enough - but they should also consider why 70,000 foreigners a year come here for medical care.
America has better tools of diagnosis and treatment than any other nation. Consider one of my patients - Paul, an American professor living in Europe.
Paul fell and smashed his wrist in 2002; the blood supply to the joint was compromised. He was operated on in New York by Charles Melone - the same highly successful hand surgeon who had also fixed the limbs of Patrick Ewing, Don Mattingly and Zaro the baker. Afterward, proudly flexing his wrist, Paul proclaimed Europe's "no frills" system as his "health care of last resort."
In 2003, Paul developed an elevated prostate test (PSA). I urged him to return to New York for a biopsy, to rule out prostate cancer. But he couldn't afford the trip or the procedure. He was living in Copenhagen, and the doctors there told him they thought the abnormal result was due to benign prostatic hypertrophy, not cancer.
Only in late 2005, as his PSA continued to rise, was I finally able to convince Paul's Danish urologist to perform the biopsy. The results were normal - but it was a "no-frills" biopsy with only four samples taken, half what's usual here.
Sure enough, Paul's PSA rose even higher, and he began to have more trouble urinating. He finally had the biopsy repeated in Greece (where he now lives) this summer - and it was positive for cancer in both lobes of the gland.
Paul's doctors in Greece recommended immediate radical prostatectomy to remove the diseased prostate. After Paul called me, I contacted Dr. Herb Lepor, the chairman of urology at NYU, who has done more than 3,000 of these procedures and is a pioneer of the nerve-sparing technique that helps preserve sexual function. Lepor said he didn't know of a surgeon as specialized and experienced in Greece.
Unfortunately, Paul's European insurance wouldn't cover an American operation, and Paul could no longer afford it (he'd barely been able to afford the wrist work years before). Instead, he had to settle for a local surgeon at the state hospital in Athens (who came well recommended by other Greek doctors and patients). The operation is next week, and I nervously await the result.
Paul's insurance will cover everything, so his choice seems reasonable - but far from perfect. The latest study shows that survival rates after five years with prostate cancer are 77.5 percent in Europe, versus 99.3 percent here.
One more anecdote: I arranged the medical care for the prime minister of a large Asian country during his recent diplomatic mission here. His personal physician from home stood idly by as the patient visited one top U.S. specialist after another. The PM ended his visit waiting behind another Asian prime minister for a special brain procedure they both knew they could never get back home.
Dr. Marc Siegel teaches at the NYU School of Medicine.
THE WORLD'S TOP MEDICINE
By MARC SIEGEL
October 5, 2007 -- CRITICS of the U.S. health-care system point to the 100,000 or so Americans who go overseas for treatment each year, typically citing lower costs. Fair enough - but they should also consider why 70,000 foreigners a year come here for medical care.
America has better tools of diagnosis and treatment than any other nation. Consider one of my patients - Paul, an American professor living in Europe.
Paul fell and smashed his wrist in 2002; the blood supply to the joint was compromised. He was operated on in New York by Charles Melone - the same highly successful hand surgeon who had also fixed the limbs of Patrick Ewing, Don Mattingly and Zaro the baker. Afterward, proudly flexing his wrist, Paul proclaimed Europe's "no frills" system as his "health care of last resort."
In 2003, Paul developed an elevated prostate test (PSA). I urged him to return to New York for a biopsy, to rule out prostate cancer. But he couldn't afford the trip or the procedure. He was living in Copenhagen, and the doctors there told him they thought the abnormal result was due to benign prostatic hypertrophy, not cancer.
Only in late 2005, as his PSA continued to rise, was I finally able to convince Paul's Danish urologist to perform the biopsy. The results were normal - but it was a "no-frills" biopsy with only four samples taken, half what's usual here.
Sure enough, Paul's PSA rose even higher, and he began to have more trouble urinating. He finally had the biopsy repeated in Greece (where he now lives) this summer - and it was positive for cancer in both lobes of the gland.
Paul's doctors in Greece recommended immediate radical prostatectomy to remove the diseased prostate. After Paul called me, I contacted Dr. Herb Lepor, the chairman of urology at NYU, who has done more than 3,000 of these procedures and is a pioneer of the nerve-sparing technique that helps preserve sexual function. Lepor said he didn't know of a surgeon as specialized and experienced in Greece.
Unfortunately, Paul's European insurance wouldn't cover an American operation, and Paul could no longer afford it (he'd barely been able to afford the wrist work years before). Instead, he had to settle for a local surgeon at the state hospital in Athens (who came well recommended by other Greek doctors and patients). The operation is next week, and I nervously await the result.
Paul's insurance will cover everything, so his choice seems reasonable - but far from perfect. The latest study shows that survival rates after five years with prostate cancer are 77.5 percent in Europe, versus 99.3 percent here.
One more anecdote: I arranged the medical care for the prime minister of a large Asian country during his recent diplomatic mission here. His personal physician from home stood idly by as the patient visited one top U.S. specialist after another. The PM ended his visit waiting behind another Asian prime minister for a special brain procedure they both knew they could never get back home.
Dr. Marc Siegel teaches at the NYU School of Medicine.
