The Chemo Concession Persists - Part II
"In sum, far from limiting access," the changes under the law "actually increased the likelihood that lung cancer patients received chemotherapy," said Dr. Mireille Jacobson of the RAND Corporation, who was first author on the study. (Disclosure: I serve as a reviewer of scientific studies for RAND.)
The authors chose to focus on lung cancer because of the various treatment
options, some of which are considerably more expensive than others. They
found that doctors frequently switched drugs to choose the more expensive
options. There was, for instance, an increased use of docetaxel (Taxotere), a
drug for which oncologist get reimbursed about $2,500 per patient per month.
"The financial incentive seemed to have an effect where there's not
strong evidence or more than one equally good treatment option," said
Craig C. Earle, MD, of Toronto, one of the study authors.
Oncologists responded by treating a greater number of patients because they
had been making so much money under the old system, Prof. Joseph P. Newhouse
of Harvard University, another co-author, told the New York Times.
"These markups were a substantial portion of their income" (Abelson
2010).
The bottom line is that some oncologists in private practice make crucial
treatment decisions not based on medical necessity but on what is most
profitable for themselves.
Oncologists are highly skilled professionals, who deserve our support and
respect. However, the "chemotherapy concession" introduces a
temptation for oncologists in private practice to prescribe according to
their economic interests rather than the medical needs of their patients.
This has no scientific or moral justification. Congress still needs to thoroughly
investigate and fix this problem.
--Ralph W. Moss, Ph.D.
© Lloyd Wright {dot} org