Physicians

PHYSICIANS/PHARMA: The oncologists’ chemo junket flies above the radar

You may have heard just a few things on THCB from Greg Pawelski, Matt Quinn, me and others about the oncologist prescribing franchise, and how it might just change physicians’ behavior a tad. Well Greg informs me that last Thursday the whole issue made it onto the NBC Nightly News.

Greg also notes that the community oncologists (well, he calls them something rather ruder, but he’s insulting the world’s oldest profession so I won’t use his language) have their own response. They are “outraged!”

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Dawn HolcombeMichellejason dPeterGregory D. Pawelski Recent comment authors
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Gregory D. Pawelski
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Gregory D. Pawelski

[I found out the above was written by Brian R. Klepper, PhD, President of The Center for Practical Health Reform.] I’m being accused by Dawn Holcomb of calling a spade (guess what?) a spade. Imagine that? The shift, some 20 years ago, from the institution-based, inpatient setting to community-based, ambulatory sites for treating the majority of the nation’s cancer patients has prompted in large part additional costs to the government and Medicare beneficiaries. The Chemotherapy Drug Concession gave oncologists the financial incentive to select certain forms of chemotherapy over others because they receive higher reimbursement. Typically, doctors give patients prescriptions… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

Prove that Community Oncologists Put Patients Before Profits A recent Health Affairs (1) article, given play in The New York Times (2), showed that the prescribing behaviors of oncologists caring for Medicare patients between 1995 and 1998 were influenced by the lucrative economics and their drug retailing arrangements. The study’s investigative team was comprised of prominent researchers, including a Dana-Farber oncologist. When interviewed, the investigators were emphatic that the study found strong links between oncologists’ financial interests and their clinical decisions. Few healthcare professionals outside the oncology community were surprised. It is common knowledge that most oncologists integrate drug revenues… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

Reimbursements Sway Oncologists’ Drug Choices
Online Journal of Health Ethics, Vol 1, No 1 (2006)
http://ethicsjournal.umc.edu/ojs2/index.php/ojhe/article/view/50

Gregory D. Pawelski
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Gregory D. Pawelski

Medicare Coverage for Cell Culture Assays Favorable local coverage decision (LCD) regarding Medicare payment for Cell Culture Assay Test Cell culture assay technology has been clinically validated for the selection of optimal chemotherapy regimens for individual patients. It is a laboratory analysis based on tumor tissue profiling that uses fresh human tumor biopsy or surgical specimen to determine which drugs or combinations of chemotherapeutic agents have the highest likelihood of response for individual cancer patients. Individualized assay-directed therapy is based on the premise that each patient’s cancer cells are unique and therefore will respond differently to a given treatment. This… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

Oncologists are among the most highly-paid of the internal medicine sub-specialties. Office chemotherapy has made thousands of oncologists not just prosperous but rich. Office chemotherapy has served as an incentive to overtreat with infusion chemotherapy and to encourage the patient to receive 2nd, 3rd, and 4th line chemotherapy, regardless of the likelihood of meaningful benefit. The system creates a hopeless conflict of interest, in that certain forms of chemotherapy are much more remunerative than others. ASCO and other fraternal organizations have never felt the need to perform clinical trials to determine whether or not treatment outcomes and patient satisfaction are… Read more »

Dawn Holcombe
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Dawn Holcombe

Mr. Pawelski definitely shows a bias, and unfortunately a general misunderstanding of the process of cancer treatment and the payment system surrounding it. The payment process for drugs that has been recently overhauled, albeit still inaccurately within Medicare, was originally designed by the government and forced upon the oncologists. Numerous initiatives by both physicians and the government to adjust it over the years failed due to the recognition that cancer care was extremely complex AND that the current payment structure (which did pay about 20% more than the average cost of drugs) was actually subsidizing a fatal under-reimbursement system on… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

The closer that people look at what we are saying, the more they will understand that what we are saying is true.
The closer that people look at what ASCO has been doing, the more they will be unsettled, if not downright apalled.

Michelle
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Michelle

Last post filled with the logical fallacy
PROOF OF THE NEGATIVE.
http://en.wikipedia.org/wiki/Negative_proof
Therefore, the logic of the above post is without merit.

Gregory D. Pawelski
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Gregory D. Pawelski

Besides bacterial culture and sensitivity testing and cell culture assay tests, there is also estrogen receptor, progesterone receptor, Her2/neu, immunohistochemical staining for tumor classification, OncotypeDX, EGFR amplification/mutation, CT, MRI, Pet Scans to measure tumor response to treatment, that have been validated for predictive accuracy. There is no evidence to the contrary, no evidence that these arn’t beneficial, and no evidence that there isn’t any benefit of assay-directed therapy over standard treatment protocol. In light of the precious little in the way of guidance from clinical trials with respect to best empiric therapy (where the only thing that has been proven… Read more »

Michelle
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Michelle

The mantra continues: “Why are they afraid to honestly evaluate and report the “accuracy” of cell culture assay tests?” Afraid? Ad hominems flow freely. With absolutely no evidence at all that cell assays are of any benefit we still have one blogger on this planet that will continue his assault on medical science. Fortunately, science continues to win over speculation. Diagnostic accuracy does not necessarily result in improved management outcome for patients, yet he wants us all to pay for his tests. He ill equate this bacterial C&S tests and their approval. A bad analogy, again. He needs to refresh… Read more »

Gregory D. Pawelski
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Gregory D. Pawelski

As you can see, Michelle is well aware that ASCO itself, will no longer go unchallenged. Why are they afraid to honestly evaluate and report the “accuracy” of cell culture assay tests? The tests have been proven “accurate.” And there are obviously lots of situations where a rational oncologist and patient would conclude that the evidence from an “accurate” test would be of help to guide treatment for cancer patients. No other lab test in history has anything other than evidence of “accuracy” to either commend it or condemn it. But ASCO won’t even look at the “accuracy.” They are… Read more »

Michelle
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Michelle

Mr. Pawelski blogs unproven hypotheses with abandon.
I direct you to a discourse on another blog between Mr. Pawelski and myself. He will no longer go unchallenged.
http://www.thecancerblog.com/2006/09/07/effective-treatment-for-breast-cancer-that-has-spread-to-the-bra/#c2261625
Michelle

Peter
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Peter

Jason, where did I say doctors are “worthless”? But they can increase their worth by not always thinking healthcare is all about them. I don’t choose doctors services like I choose a hot dog, I need doctors sevices like I need oil companies to buy gas from, (another monopoly) but the goals and issues of oil companies are not mine or are they in the long term interests of the nation and the problems we face. If doctors acted more as patient advocates then I think the public would overwhelmingly get behind them. But getting the AMA (doctors union) out… Read more »

jason d
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jason d

“Docs (in general) are not part of the solution, they are an impediment to solutions in healthcare.”
Uhh… if doctors are worthless then why in god’s name do you choose to use their services? By all means go to your neighbor down the street and see if he can propose a remedy for your symptoms.

Peter
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Peter

Docs (in general) are not part of the solution, they are an impediment to solutions in healthcare.