Further thoughts on Provenge usage and institutional "politics"

[dhccpa]

In my researching into Provenge (both the treatment itself and where to receive it), and in reviewing posts on PCa forums (perhaps mostly other forums besides this one), I've noticed some interesting patterns.

Provenge was approved around 2010 and had a troubled opening. The small company, after long FDA trials, had little money to market it well, had trouble getting quick Medicare and insurance carrier approval, other drugs that promised good results (alternatives to using Provenge, but not direct competitors as immunotherapy) that were cheaper or secured coverage quickly. So Provenge ground somewhat to a half, but seemingly has (slowly) gotten a second life during the last 10 years.

Many clinics and large institutions, including apparently many "centers of excellence," do but use it as all. Places that do use it, of course, recommend it, explain it, etc.

But those places that don't offer also don't seem to mention (much less recommend) it to patients. Some even seem to badmouth it, saying the original FDA clinical trials were flawed and effectively useless. Some even say that one large center profits from it and recommends it for that reason (I think they mean UCLA). The clinical trial criticism has been around for years and popped up when the company sought European approval, which it got (I don't think it's done well there, though). Supporters and detractors on both sides.

All this is notable because I've long suspected that economic and other interests drive clinical recommendations, even to the various hormone meds. When I was first diagnosed in 2018, my urologist was going to put me on Firmagan. I left him to see an oncologist. I saw several at different clinics, none of which used Firmagan, including the one I've been using for over six years. Over the years, I've asked the various nurses who give the Lupron shots and none are familiar with Firmagan. At other clinics the situation may be the reverse.

I suspect this affects sequencing of treatments, used of various types of radiation, whether to double up or triple up on treatments (or stick to the "wait till this one fails" strategy), etc.

Anyone else notice this phenomenon?

[MelodyCat]

I know there will be people who will call me a conspiracy theorist but it is worse than that. The economics of profit (I am a capitalist) come into play when they have costs to recoup and longer term treatments mean a more recurring revenue stream. Also, the funding of research is often from governments which would have a significant problem funding Social Security and pensions if life expectancies skyrocketed. Doubt this? Explain why almost no research goes to stem-like sensescent cells that are the real reason why treatments are always palliative when cancer is metastatic. That is not to say that the researchers themselves don’t want to do the right thing, they just don’t get the funding.