SHOULD DC GOV REGULATE THE PHARMACEUTICAL COMPANIES?

[Psycho]

WHY DOCTORS PREFER ONE DRUG OVER ANOTHER

 

 

If you have been diagnosed with cancer then you might be shocked to know that your doctors’ choices for treatment of you is rooted in what drug or procedure offers them the biggest profit margin.

 

The joint Michigan/Harvard study confirms medical oncologists choose cancer chemotherapy based on how much money the chemotherapy earns the medical oncologist.

 

This study adds to the "smoking gun" study of Dr. Neil Love ("Patterns of Care") on the subject.[1] The results of his 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.

 

Once a decision to give chemo is taken, physicians receiving more-generous Medicare reimbursements used more-costly treatment regimens.

 

What was interesting about the "Patterns of Care" study was that it is contemporary, after the Medicare reform. It shows that the Medicare reforms haven't solved the problem. It's not that all oncologists are bad people. It's just an impossible conflict of interest, it's the system which is rotten. The solution is to change the system. So far, Medicare reform hasn't achieved that.

 

Two scientific, "evidence-based" studies giving a dose of reality.

 

The shift in the United States, more than 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 Concession gave oncologists the financial incentive to select certain forms of chemotherapy over others because they receive higher reimbursement.

 

This was first brought to attention at a Medicare Coverage Advisory Committee meeting in 1999, in Baltimore, Maryland. There was a gastroenterologist in attendance who complained that Medicare had cut his reimbursement for colonoscopies from $400 to $108 and how all the doctors in his large, multispecialty internal medicine group were hurting, save for two medical oncologists, whom he said were making a killing running their in-office retail pharmacies.

 

Typically, doctors give patients prescriptions for drugs that are then filled at pharmacies. But medical oncologists bought chemotherapy drugs themselves, often at prices discounted by drug manufacturers trying to sell more of their products, and then administered them intravenously to patients in their offices.

 

Not only do the medical oncologists have complete logistical, administrative, marketing, and financial control of the process, they also control the knowledge of the process. The result is that the medical oncologist selects the product, selects the vendor, decides the markup, conceals details of the transaction to the degree they wish, and delivers the product on their own terms including time, place, and modality.

 

The joint Michigan/Harvard study published in Health Affairs, to which I'm writing in response, confirmed that before the new Medicare reform, medical oncologists are more likely to choose cancer drugs that earn them more money. A survey by Dr. Neil Love, published in Patterns of Care, produced results showing that the Medicare reforms have not solved the problem of variations in oncology practice.

 

A patient wants a physician's decision to be based on experience, clinical information, new basic science insights, and the like, not on how much money the doctor gets to keep. A patient should know if there are any financial incentives at work in determining what cancer drugs are being prescribed.

 

It's not that all medical oncologists are bad people. It's just that the system is rotten and still poses an impossible conflict of interest. Some oncologists prescribe chemotherapy drugs with equal efficacies and toxicities. I would imagine that some are influenced by the whole state of affairs, possibly without even entirely admitting it. Social science research shows that people can be biased by self-interest without being aware of it.

 

There are so many ways for humans to rationalize their behavior.

 

There is some innate goodness of people who go into oncology. At the time when most oncologists practicing today made the decision to become oncologists, there was no Chemotherapy Concession. Most of them probably had a personal life experience which created the calling to do battle against the great crab. At the time when people make their most important decisions in life, they are in the most idealitstic period of their lives.

 

The U.S. government wasn't reducing payment for cancer care under the new Medicare Modernization Act (MMA) of 2003. It was simply reducing overpayment for chemotherapy drugs and paying cancer specialists the same as other physicians. The government can't afford to overpay for drugs, in an era where all these new drugs are being introduced, which are fantastically expensive.

 

Although the new Medicare bill tried to curtail the Chemotherapy Concession, private insurers still go along with it. What needs to be done is to remove the profit incentive from the choice of drug treatments. Medical oncologists should be taken out of the retail pharmacy business and allowed to be doctors again. The solution is not to put the doctors in jail; it's to change the system.

 

Jonathan R. Rees, Health Care Administrator

Kathleen Kravitz, Oncology Nurse

Gregory D. Pawelski, Health Care Advocate

[Guest Guest]

Gee, that wasn't completely plagerized from:

 

http://content.healthaffairs.org/cgi/eletters/25/2/437

 

I wonder if Mr. Pawelski knows that Mr. Rees is "borrowing" his work?

 

WHY DOCTORS PREFER ONE DRUG OVER ANOTHER

 

 

If you have been diagnosed with cancer then you might be shocked to know that your doctors’ choices for treatment of you is rooted in what drug or procedure offers them the biggest profit margin.

 

The joint Michigan/Harvard study confirms medical oncologists choose cancer chemotherapy based on how much money the chemotherapy earns the medical oncologist.

 

This study adds to the "smoking gun" study of Dr. Neil Love ("Patterns of Care") on the subject.[1] The results of his 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.

 

Once a decision to give chemo is taken, physicians receiving more-generous Medicare reimbursements used more-costly treatment regimens.

 

What was interesting about the "Patterns of Care" study was that it is contemporary, after the Medicare reform. It shows that the Medicare reforms haven't solved the problem. It's not that all oncologists are bad people. It's just an impossible conflict of interest, it's the system which is rotten. The solution is to change the system. So far, Medicare reform hasn't achieved that.

 

Two scientific, "evidence-based" studies giving a dose of reality.

 

The shift in the United States, more than 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 Concession gave oncologists the financial incentive to select certain forms of chemotherapy over others because they receive higher reimbursement.

 

This was first brought to attention at a Medicare Coverage Advisory Committee meeting in 1999, in Baltimore, Maryland. There was a gastroenterologist in attendance who complained that Medicare had cut his reimbursement for colonoscopies from $400 to $108 and how all the doctors in his large, multispecialty internal medicine group were hurting, save for two medical oncologists, whom he said were making a killing running their in-office retail pharmacies.

 

Typically, doctors give patients prescriptions for drugs that are then filled at pharmacies. But medical oncologists bought chemotherapy drugs themselves, often at prices discounted by drug manufacturers trying to sell more of their products, and then administered them intravenously to patients in their offices.

 

Not only do the medical oncologists have complete logistical, administrative, marketing, and financial control of the process, they also control the knowledge of the process. The result is that the medical oncologist selects the product, selects the vendor, decides the markup, conceals details of the transaction to the degree they wish, and delivers the product on their own terms including time, place, and modality.

 

The joint Michigan/Harvard study published in Health Affairs, to which I'm writing in response, confirmed that before the new Medicare reform, medical oncologists are more likely to choose cancer drugs that earn them more money. A survey by Dr. Neil Love, published in Patterns of Care, produced results showing that the Medicare reforms have not solved the problem of variations in oncology practice.

 

A patient wants a physician's decision to be based on experience, clinical information, new basic science insights, and the like, not on how much money the doctor gets to keep. A patient should know if there are any financial incentives at work in determining what cancer drugs are being prescribed.

 

It's not that all medical oncologists are bad people. It's just that the system is rotten and still poses an impossible conflict of interest. Some oncologists prescribe chemotherapy drugs with equal efficacies and toxicities. I would imagine that some are influenced by the whole state of affairs, possibly without even entirely admitting it. Social science research shows that people can be biased by self-interest without being aware of it.

 

There are so many ways for humans to rationalize their behavior.

 

There is some innate goodness of people who go into oncology. At the time when most oncologists practicing today made the decision to become oncologists, there was no Chemotherapy Concession. Most of them probably had a personal life experience which created the calling to do battle against the great crab. At the time when people make their most important decisions in life, they are in the most idealitstic period of their lives.

 

The U.S. government wasn't reducing payment for cancer care under the new Medicare Modernization Act (MMA) of 2003. It was simply reducing overpayment for chemotherapy drugs and paying cancer specialists the same as other physicians. The government can't afford to overpay for drugs, in an era where all these new drugs are being introduced, which are fantastically expensive.

 

Although the new Medicare bill tried to curtail the Chemotherapy Concession, private insurers still go along with it. What needs to be done is to remove the profit incentive from the choice of drug treatments. Medical oncologists should be taken out of the retail pharmacy business and allowed to be doctors again. The solution is not to put the doctors in jail; it's to change the system.

 

Jonathan R. Rees, Health Care Administrator

Kathleen Kravitz, Oncology Nurse

Gregory D. Pawelski, Health Care Advocate

[Psycho]

Mr. Pawelski is a friend of ours and asked that we post it because of his concerns which are identical to ours'.

 

 

Gee, that wasn't completely plagerized from:

 

http://content.healthaffairs.org/cgi/eletters/25/2/437

 

I wonder if Mr. Pawelski knows that Mr. Rees is "borrowing" his work?

[Guest human_*]

Rees is 100% correct in posting this topic.

 

The only things that interest me; Is the Quality of patient care, and the patients being FULLY informed

of their options, and the health care system is failing in that.

 

There is alot of serious institutional issues out there that need to be addressed, before we as a society

could even begin to address universal health care.

 

 

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Gee, that wasn't completely plagerized from:

 

http://content.healthaffairs.org/cgi/eletters/25/2/437

 

I wonder if Mr. Pawelski knows that Mr. Rees is "borrowing" his work?

[Psycho]

Often when doctors send you on for surgery, they don't lay it all out.

 

I mean, they do not:

 

1. Tell you how extensive the surgery will be;

2. What else might they cut out;

3. How much discomfort you will really feel;

4. What kind of post-op therapy you might face; or

5. How might time you might lose from work.

 

All patients are told that they do not know until they cut you open and go inside, but by then you are out like a light and do not know what is going on.

 

Rees is 100% correct in posting this topic.

 

The only things that interest me; Is the Quality of patient care, and the patients being FULLY informed

of their options, and the health care system is failing in that.

 

There is alot of serious institutional issues out there that need to be addressed, before we as a society

could even begin to address universal health care.

----------------------------------------------------------------------------------------------------------------------

[Guest human_*]

Yeap, that is very true. I was left to my own devices to figure it all out.

 

The rule of thumb is for an open wound "healing it from the inside out" is; How ever long it takes for the tissue to regranulate, it will also take the same amount of time for the skin to form.

 

Also a high protein diet "steaks, burgers" things like that.

 

Oh baby!! I learned that one the hard way.

 

Skin integrity goes down by 30% after you have healed, and it goes further down the more they operate.

 

Even one that is closed you can bank on, on at least 6 months to heal.

People, no matter what other posts I've posted in here? pretty, pretty, pretty please, pretty please,

TAKE THIS ONE TO HEART.

 

I really wished that I didn't know about this stuff.

 

----------------------------------------------------------------------------------------------------------------------

Often when doctors send you on for surgery, they don't lay it all out.

 

I mean, they do not:

 

1. Tell you how extensive the surgery will be;

2. What else might they cut out;

3. How much discomfort you will really feel;

4. What kind of post-op therapy you might face; or

5. How might time you might lose from work.

 

All patients are told that they do not know until they cut you open and go inside, but by then you are out like a light and do not know what is going on.

[Psycho]

Take lung cancer as an example.

 

Diagnosing and treating it is more an art than a science for doctors as I work with them day in and day out.

 

With any form of cancer, doctors cannot tell you what to expect because everybody is so different.

 

Here it is waiting game for each individual.

 

 

 

Yeap, that is very true. I was left to my own devices to figure it all out.

 

The rule of thumb is for an open wound "healing it from the inside out" is; How ever long it takes for the tissue to regranulate, it will also take the same amount of time for the skin to form.

 

Also a high protein diet "steaks, burgers" things like that.

 

Oh baby!! I learned that one the hard way.

 

Skin integrity goes down by 30% after you have healed, and it goes further down the more they operate.

 

Even one that is closed you can bank on, on at least 6 months to heal.

People, no matter what other posts I've posted in here? pretty, pretty, pretty please, pretty please,

TAKE THIS ONE TO HEART.

 

I really wished that I didn't know about this stuff.

 

----------------------------------------------------------------------------------------------------------------------