Physicians

PHARMA/PHYSICIANS: Smoking Gun on the Chemotherapy Drug Concession? by Greg Pawelski

Neil Love, M.D. reports from a survey of breast cancer oncologists based in
academic medical centers and community based, private practice oncologists. The
academic center-based oncologists do not derive personal profit from the
administration of infusion chemotherapy, while the community-based oncologists do
derive personal profit from infusion chemotherapy, while deriving no profit from
prescribing oral-dosed chemotherapy.

The results of the survey show that for first line chemotherapy of metastatic
breast cancer, 84-88% of the academic center-based oncologists prescribed an
oral dose drug (capecitabine), while only 13% prescribed infusion drugs, and
none of them prescribed the expensive, highly remunerative drug docetaxel.

In contrast, among the community-based oncologists, only 18% prescribed the
oral dose drug (capecitabine), while 75% prescribed infusion drugs, and 29%
prescribed the expensive, highly remunerative drug docetaxel. The existence of
this profit motive in drug selection has been one of the major factors working
against the individualization of cancer chemotherapy based on testing the cancer
biology.

This is not to imply that the academic center-based oncologists are without
their fair share of collective guilt. They were misguided in not recognizing
that they were trying to mate notoriously heterogeneous diseases into
one-size-fits-all treatments. They devoted 100% of their clinical trials
resources into trying to identify the best treatment for the average patient, in
the face of evidence that this approach was non-productive. However, such
unsuccessful experiments will never be viewed as such by the thousands of people
whose careers are supported by these experiments.

Henderson, et al, entered 3,100 breast cancer patients in a prospective,
randomized study to compare cyclophosphamide/doxorubicin alone versus
cyclophosphamide/doxorubicin plus Taxol (in the adjuvant, pre-metastatic
setting). The results were microscopically positive, at best, and cannot begin
to justify the enormous financial and human resources expended (while making no
effort at all to test and improve methods to individualize treatment).

But these results changed the face of the adjuvant chemotherapy of breast
cancer.

Cyclophosphamide+Doxorubicin+Taxol became standard of care. Taxol recently
went off patent. Now the thrust is to identify on-patent therapy which is
microscopically better in clinical trials of one-size-fits-all treatment.
Already, the community-based oncologists are migrating to
Cyclophosphamide+Doxorubicin+Docetaxel (expensive/remunerative) so what was the
purpose of doing that 3,100 patient prospective, randomized Henderson study?

 

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Greg PawelskidimisGregory D. PawelskiGreg PawelskiJeet Recent comment authors
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Greg Pawelski
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Greg Pawelski

Pharmaceutical Industry Average Wholesale Price Litigation If anyone took any of these chemotherapy drugs between January 1, 1991 to December 31, 2004, you may receive reimbursement if you made a percentage co-payment or full payment for the following drugs: Blenoxane Cytoxan Etopophos Paraplatin Rubex Taxol Vepesid Over the course of the 1990’s, oncologists have been able to rely on the “sale” of chemotherapy drugs as an important source of revenue. Some oncologists acknowledge that the system created a perverse incentive. According to Dr. Edward L. Braud, from the Association of Community Cancer Centers, whose members treat more than half of… Read more »

dimis
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The surgical procedure of removing tumors that are cancerous, the adjuvant treatment approach is essentially whichever kind of chemotherapy applied assuming there is no left-behind malignant cells. At this point preventive medicine is practiced by means of a sequence of treatments. The objective here is to help ensure no reappearance of the cancer growth. Using this method not only aids in preventing a recurrence during post-surgery, but definitely gives the patient a bit of a relief.

Gregory D. Pawelski
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Gregory D. Pawelski

The Oncologists’ Guaranteed Employment Act of 1998 Hippocrates opined “first do no harm.” Osler preached above all else “examine the patient.” Salk asked us to “prevent the disease.” Which preeminent physician commanded that before anything else, “pre-radiate and administer chemotherapy for the tumor?” None, as far as this medical editor knows, but in 1998 this is the policy for all newly diagnosed patients with stage II-III gastrointestinal malignancies. No surgical excision of the tumor is to be performed before administration of weekly doses of 5-FU and daily irradiation of the tumor. The idea in colorectal carcinoma is that the tumor… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

All over-the-counter drugs you purchase at the pharmacy, have dosage, usage and side-effect declarations on the label. Even prescription drugs that are purchased from a pharmacy have print-out and/or labels. It has been brought to my attention, under the concept of the Chemotherapy Drug Concession, the oncologist’s office (except for some urologists) is the only place you can buy drugs that are not labeled. This means that “informed consent” is the only thing close to “labeling” of these chemo agents. Numerous oncologists have been playing fast and loose with “informed consent,” many times ignoring it in spite of the fact… Read more »

Greg Pawelski
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Greg Pawelski

Compared to infusional therapy, oral-dose anti-cancer drugs can make receiving cancer treatment more convenient for patients by allowing flexibility in taking medication without disrupting work or other activities. They can often result in less time (or no time) spent in office-based oncology practices because of the absence of intravenous administration and its related side-effects. How many oncologists have been thinking of giving a patient oral chemotherapy, instead of infusional therapy? I wonder how much of that extra $130 paid per infusional-chemotherapy recipient per treatment day, helped to make their decision? Ammendities at hospitals are just as accommodating as office-based infusion… Read more »

Jeet
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Jeet

If it makes you feel any better the Medicare Modernization Act puts into effect (starting in 2006) mechanisms that limit doctor’s reimbursement for drugs. Although this imbalance may still occur, it will be great deal less.
On the minus side, lots of oncologists and other doctors will now be sending patients to hospitals to receive their infusions.

Matt
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Matt

While such studies seem to demonstrate that physician compensation drives treatment decisions, I’m sure that there are other, logical explanations for these differences in behavior. I just don’t know what they are…