Robert Reitzen isn’t one to blindly follow doctors’ orders — and he’s better off for it.
Reitzen, a partner in a Los Angeles-based hedge fund, believes more in math — and the value of doing your own research — than in medical verbiage. In late 2005, an MRI for an unrelated health issue revealed that the then-45-year-old had kidney cancer. Upon hearing the news, he remembers feeling sick to his stomach and dreading the prospect of losing an organ.
“I asked the doctor for a tranquilizer prescription,” he says. “I was completely stunned.”
A day later, he was referred to a urological surgeon, who anticipated operating on the cancer.
“The doctor came up to my house and had fantastic bedside manner,” says Reitzen, now 57. “He told me that the tumor was larger than the kidney itself, which would necessitate removing my kidney and the lymph nodes around it.”
But Reitzen didn’t want a body part removed — unless data showed it to be absolutely necessary — so he sought a second opinion. He aimed to find a surgeon who would remove the cancer while leaving his kidney and lymph nodes intact.
In questing to uncover a suitable surgeon, he was inspired by software that recognizes keywords in analysts’ reports that move stocks. Reitzen and the mathematicians who work with him designed a similar application for doctor hunting. It data-mined the Internet for keywords linked to highly regarded surgeons. While search terms included kidney cancer, renal cell cancer and partial nephrectomy, the program also sought surgeons who had written well-received papers on these topics.
Two clear winners emerged, one of whom was Dr. Arie Belldegrun, the surgical director of genitourinary oncology at UCLA Health, who said kidney removal wasn’t desirable.
“The surgeon thought that it would be better for me not to lose it because I had high blood pressure, which can destroy a kidney over time. Also, since I was only 45, it would be better to not go through life with just one kidney,” says Reitzen. “He had no bedside manner, but I liked his opinion of there being a 70 percent chance that I would not be left with just one kidney.”
Reitzen’s operation one month later — which entailed Belldegrun removing the kidney, extracting the cancer, reshaping the organ and putting it back — was a success. But the oncologist/hematologist who gave him the original diagnosis suggested chemotherapy to avoid a recurrence.
The chemo he would have undergone was a trial that showed promising results. Normally, though, chemotherapy is used to treat kidney cancer as a last-ditch effort, so Reitzen wanted to analyze whether or not the course of treatment, and all its side effects, would be worth it.
“Do your own research and get copies of all blood work and scans,” he says. “Check them out for yourself rather than waiting on overworked doctors and their assistants to look at them for you.”
Using decision-theory math, Reitzen took into account the likelihood of surviving with and without chemo. With the chemo, there was an average life expectancy of 8.1 years; without it, he would be looking at 7 years.
But taking chemo’s side effects into account, his quality of life would be only 70 percent, which he based on information from health-related quality-of-life studies on chemotherapy patients. Without the chemo, he would have no side effects and 100 percent quality of life. After doing the math, quality-adjusted life years came to 5.7 with chemo and 7 without.
“Would you want to exchange a 15 percent life-expectancy increase for a 30 percent drop in quality of life?” he asks.
Would you want to exchange a 15 percent life-expectancy increase for a 30 percent drop in quality of life?
Reitzen’s doctor, the original oncologist, was surprisingly cool with the decision and said his calculations made sense.
While Reitzen routinely makes critical investment decisions with the guidance of math, and found comfort in his cancer-by-the-numbers strategy, doctors don’t think his approach to treatment should be relegated only to statistics-loving professionals.
“This idea of giving people control over their lives is something to applaud,” says Dr. Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center. “When the expected benefit isn’t that large and there are negatives, it’s desirable for patients to take the situations into their own hands.”
Reitzen felt that when it came to running numbers, he understood that realm better than the medical professionals.
“A friend who knew about math and medicine told me that a lot of doctors are notoriously bad at probabilities — another, though, thought I was crazy and told me that I should listen to my doctor and do the chemo,” Reitzen says. “But I didn’t tell a lot of people about my decision. I didn’t want a lot of attention. My daughter asked me if I was going to die. I told her that I hoped not any time soon and felt like I was letting her down.”
Ten years later, Reitzen is cancer-free, with two functioning kidneys, and did not have to endure the misery of chemotherapy. The treatment that he was initially offered has been deemed ineffective for kidney cancer.
“I didn’t know if I made the right decision or not,” Reitzen says of the uncertainty he felt at the time. “I went with logic, because that’s the only way I know how to do things.”
Our editors found this article on this site using Google and regenerated it for our readers.
