Prostate-specific antigen concentration: influence of age and ethnicity.

This pilot study evaluated the influence of age and ethnicity on serum prostate-specific antigen (PSA) concentration in Asian and white men without a clinical diagnosis of prostate cancer. Between October and December 1993, 1260 patients who underwent serum PSA determination (Hybritech Tandem-R assay, San Diego, California) at Straub Clinic & Hospital were retrospectively analyzed. Of these, 885 (70%) men aged 40 to 79 years were either Asian (Chinese, Filipino, Japanese, and Korean) or white and had a serum PSA less than 10.0 ng/ml. The PSA for the entire group was 2.1 +/- 2.0 ng/ml (mean +/- SD). PSA correlated with age (r = 0.31, p = 0.0001) and age accounted for 10% of the variance in serum PSA. Using the regression formula, serum PSA increased 2.5% (0.06 ng/ml) per year of age. The entire study group was about equally divided between whites (49%) and Asians (51%). Nearly three-fourths of the Asian men were Japanese. The mean PSA was very close in the Asian and white groups. There was no direct correlation between serum PSA and ethnicity (r = 0.03; p = 0.3201). Ethnicity contributed 0.1% of the variance in PSA. In conclusion, this preliminary study suggests serum PSA increases with age in Asian and white men without a clinical diagnosis of prostate cancer. No difference was found in PSA between men of Asian and white ethnicity.

The case for restructuring health care in the United States: the Hawaii paradigm.

Health care in the United States is plagued by many problems. This includes excessive specialization with too few generalists, burdensome bureaucratic federal rules and regulations, and outlandish malpractice awards--all contributing to costs of care that exceeds all other nations. Cost has erroneously been identified as the cause of the problem rather than being one of many results of a failing system. Rather than repetitive unsuccessful efforts to tinker with cost as the cause, it makes far more sense to design and build a better structure of health care including expanding the existing biomedical model into a broader biomedical-psychosocial model. Hawaii, with virtually 100% of its population insured, is closer to this model than most states. It also manages to be ranked the healthiest state with one of the lowest health care costs in the nation.

The superiority of antimicrosomal over antithyroglobulin antibodies for detecting Hashimoto's thyroiditis.

BACKGROUND: Antimicrosomal (anti-M) and antithyroglobulin (anti-Tg) antibodies are commonly measured together to detect Hashimoto's thyroiditis. Since this nearly doubles the cost of testing for one antibody, we wished to determine whether significant diagnostic loss would occur if the two tests were replaced by anti-M alone. METHODS: Both tests were performed in 2030 consecutive patients referred by general internists and endocrinologists. RESULTS: With a positive result defined as either test being positive at a 1:100 dilution, anti-M was much more sensitive than anti-Tg. Anti-M was positive in 99% (823/831) of all patients with positive tests, while anti-Tg was positive in 36% (302/831). Anti-M was the only positive test in 64% of all patients with positive tests, while anti-Tg was the only positive test in 1%. With a cutoff point of 1:400 dilution, the results were similar. CONCLUSIONS: Anti-M alone appears sufficient to detect autoimmune thyroid disease at about one half the cost of routinely performing both anti-M and anti-Tg studies. The widespread practice of performing both tests increases the cost without an offsetting diagnostic gain.