Money and Oncology: Be aware of financial ties

[gpawelski]

A recent article published by the National Institute of Health concluded that "about one fourth of abstracts at American Society of Clinical Oncology (ASCO) Annual Meetings have an author with a personal financial interest." Since many of these abstracts are about the results of clinical studies, this means that the study results are being penned by authors that may have a "personal financial interest" in the outcome.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17704409&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

Attitudes toward research participation and investigator conflicts of interest among advanced cancer patients participating in early phase clinical trials.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17687154&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

These two articles touch on a critical subject - when an oncologist recommends a treatment the reason behind the recommendation may be complex. It can be a result of the doctor's training and experience in combination with the investments made by the hospital or the doctors own research interests or their financial relationships with various outside entities. In short, a patient and their family must be their own best advocate and get at the heart as to why a specific treatment regimen is being suggested. Don't be afraid to ask questions to make informed treatment decisions!

Source: Cancer Wire

[gpawelski]

Cancer sufferers are taking doses of expensive and potentially toxic treatments that are possibly well in excess of what they need, medical oncologist Dr. Ian Haines reported in the Journal of Clinical Oncology. Emerging evidence shows that many of the highly expensive "targeted" cancer drugs (Herceptin, Avastin and Rituximab) may be just as effective and produce fewer side effects if taken over shorter periods and in lower doses.

He stated in the Journal that "it would seem that pharmaceutical companies are attracted to studies looking at the maximum tolerated dose of any treatments." He suggested the we make the search for minimum effective doses of these treatments one of the key goals of cancer research.
He gave as an example, Avastin, used to fight colon and lung cancers, the dose being tested is 15 milligrams per kilogram of body weight, despite other research showing it may work with 3 milligrams per kilogram.

A study published in the journal of the American Cancer Society, led by Jeffrey Peppercorn of the University of North Carolina Lineberger Cancer Center, along with three researchers at the Dana-Farber Cancer Institute, found that 84% of trials with pharmaceutical-company involvement showed positive results, compared to 54% for trials without industry backing. Another previous study in oncology, looking at multiple myeloma, found that pharmaceutical studies reported positive results in 74% of trials compared to 47% of non-industry-sponsored trials.

An increasing number of drug studies are developed through collaborations between academic medical centers and drug companies. In fact, pharmaceutical-industry investment in research exceeds the entire operating budget of the NIH. It is important to understand the influence that industry involvement may have on the nature and direction of cancer research. Studies backed by pharmaceutical companies were significantly more likely to report positive results.

As the Haines study suggests more must be spent on analyzing drug data, we also need larger and more detailed studies to figure out why there is an association between pharmaceutical involvement and positive results. Some of the connection between industry and positive results may be because industry focuses on drug development and they do it well.

However, drugmakers are going directly to the consumer at a time when their products are indeed at the margins of evidence-based medicine. On one hand, pharmaceuticals advertise extensively and the advertising is manipulative in the extreme. On the other hand, even NCI-designated cancer centers do this sort of direct to consumer, hard sell advertising. And in cancer medicine, the media advertising is no more misleading than the one-on-one communication which often goes on between a chemotherapy candidate and an oncologist.

A Karolinska Institute in Sweden study showed that U.S. health care system is good at delivering expensive drugs, but that our health care system is not so good at simple medicine like preventive care. Our pharmaceutical-based health care system is very good at creating new health care products that will make a lot of money, but it it's something that has no chance of profit, forget it.

It doesn't take a rocket scientist to figure out that the United States does a good job of developing and delivering new and expensive drugs to cancer patients, because that is the only thing we're good at. But it'll take a rocket scientist to figure out how this makes for a better health care system.

http://jco.ascopubs.org/cgi/content/full/25/25/e31

[gpawelski]

A New York Times article states that the drugs, given by injection, have been heavily advertised, and there is evidence that they have been overused, in part because oncologists can make money by using more of the drug.

http://query.nytimes.com/gst/fullpage.html?sec=health&res=9C06EEDB1331F933A25750C0A9619C8B63

According to Dr. John Glaspy, director of UCLA's Outpatient Oncology Clinic, one complicating factor, experts say, is that oncologists make significant revenue buying cancer drugs from manufacturers and charging patients a higher price for receiving the drugs in their offices. That profit motive could influence some doctors' decisions. However, patients with anemia, which can cause sluggishness in its early stages and can be fatal in advanced phases, can get blood transfusions, typically every few weeks, instead of using EPO.

Len Lichtenfeld, deputy chief medical officer for the Atlanta-based American Cancer Society, told United Press International, "Probably more than a billion dollars is spent on erythropoietin each year, which makes it one of the most expensive cancer drugs." A six-month course of treatment can cost more than $10,000 per patient.

In panel discussion that highlighted the 12th annual conference of the National Comprehensive Cancer Network, Lee Newcomer, former chief medical officer and currently an executive with Minneapolis-based United Health Group, pointed out that in reviewing records of patients who were prescribed the drug erythropoietin, said that 44% of those patients had blood work-ups that would indicate they were not anemic.

Source: ScienceDaily

U.S. Oncology takes a hit! Reports first-quarter net loss.

U.S. Oncology said a number of factors impacted the results, including reduced pre-tax income due to lower use of certain supportive care drugs used to treat cancer-induced anemia: and the discontinuation of the Medicare Demonstration Project.

http://www.bizjournals.com/houston/stories/2007/04/30/daily82.html?from_rss=1

The Senate Finance Committee Chairman found that the value of the approximately $300 million-a-year Medicare Demonstration Project to report on a patient's level of nausea, vomiting, pain and fatigue was for nothing.

CMS paid chemotherapy providers $130 per report, per infusional-chemotherapy recipient, on a patient's level of nausea, vomiting, pain and fatigue. However, HHS' inspector general's office found these providers were being paid an extra $130 to simply forward the data that was already collected.

A continuance of the Medicare Demonstration Project would have exacerbated existing economic and clinical problems instead of resolving them by increasing the temptations for physicians to overuse injectable drugs and promise to aggravate the ecnomic problems Congress attempted to fix with the new Medicare law.

U.S. Oncology Under the Gun

U.S. Oncology reports two seeming unrelated bits in their latest SEC Form 10-K. One note say cancer patients are suddenly using a lot less anemia drugs, and as a result U.S. Oncology will bank $8-10 million a year less than expected. The second note says that in 2005 the company was subpoenaed by the U.S. Department of Justice about contracts and relationships with pharmaceutical companies.

Coincidence?

http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/05-03-2007/0004579964&EDATE

Doctors Reap Millions for Anemia Drugs
By ALEX BERENSON and ANDREW POLLACK
New York Times

Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment. The anemia drugs are injected or given intravenously in physicians’ offices or dialysis centers. Doctors receive the rebates after they buy the drugs from the companies. But they also receive reimbursement from Medicare or private insurers for the drugs, often at a markup over the doctors’ purchase price.

http://www.nytimes.com/2007/05/09/business/09anemia.html?_r=2&hp=&oref=slogin&pagewanted=print&oref=slogin

It's still your mother's chemotherapy drug concession. Although the new Medicare bill tried to curtail the drug 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. Let's take physicians out of the retail pharmacy business and let them be doctors again!!!

[lor]

http://desktoppub.about.com/library/holidays/pdh002ld.gif

[gpawelski]

The cancer industry derives most of its profits from chemotherapy. Both the drug companies and the treatment providers profit from the chemotherapy drugs and the medications used to combat the side effects. The obscene profits made off chemotherapy override any incentive to find a cure or better treatments.

Doctors administer chemotherapy in their offices, buy the drugs at a lower cost than what insurance companies and public health care programs pay and pocket the difference. This system provides an incentive to overuse chemotherapy and the most expensive medications.

http://www.lawyersandsettlements.com/articles/01828/anemia-overuse.html

[gpawelski]

Is Cancer Community In Alignment About 'Cure' and 'Costs'? NCCN Conference Panel Asks

Cancer's two most compelling words these days are "cure" and "costs," and each holds capacity to create patient heartache and promise, according to roundtable participants at the National Comprehensive Cancer Network's 13th Annual Conference, March 5-9.

When doctors recommend cancer treatments, best practices dictate that they follow guidelines created by NCCN and other professional medical organizations. Currently, such guidelines do not include treatment-cost data. Leonard Saltz, M.D., of Memorial Sloan-Kettering Cancer Center said doctors traditionally assumed "we must be very sanctimonious and above the idea of considering cost." But panelists unanimously agreed - and so did the majority of the audience by a show of hands - that cost data should be appended to guidelines.

Panelist Alice Gosfield, an attorney with more than a decade of experience in oncology issues, condemned as "basically wrong" widespread reimbursement practices that profit doctors more who prescribe the most expensive drugs. She said that while it might be unfair to shoulder clinicians with the burden of factoring costs into a patient's treatment plan, insurers and others will be forced to make such decisions, and in the process "there will be blood."

Guidelines help oncologists evaluate treatments and reflect evolving professional consensus. NCCN's guidelines are the "Mercedes" of treatment standards, said David S. Ettinger, M.D., of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. In the future, adding cost data might help doctors choose between two chemotherapy regimens for colorectal cancer that, according to Saltz, are equally effective. Yet one costs $60,000 extra over the course of 10 months' of treatment.

Aetna's James D. Cross, M.D., said that Aetna covers evidence-based treatments regardless of cost. "We exclude experimental treatments from most plans," he explained, but always reimburse experimental treatment costs for cancer patients enrolled in clinical trials. "Depending upon what the evidence states, what the state of the art is, what the NCCN guidelines recommend, that is what we cover."

Cost has suddenly become more crucial to cancer patients, said Nancy Davenport-Ennis of the National Patient Advocate Foundation. Logging 6.8 million inquiries from patients in 2007, the foundation's analysis shows 70 percent of patient dilemma involved cost. That compares with only 38 percent of callers complaining of a cost problem the previous year.

As for whether the C-word - "cure" - belongs in doctor-patient discussions, Saltz argued that doctors sometimes "sugarcoat the reality" in employing the phrase "progression-free survival" to describe new cancer drugs' effectiveness. Doctors understand something patients don't, he said: the phrase refers specifically to the time span between the start of treatment and the moment the tumor begins to grow again. Doctors should not impart false hope when they know "the person is not going to live longer." He urged replacing the phrase with terminology that avoids the word "survival."

Ettinger, by contrast, defended incremental improvements in treatment that may extend patients' lifespans by only weeks or months. "Are we making advances?" he asked. "Yes. Is it slow? Yes."

National Comprehensive Cancer Network (NCCN)
Thomas Mitchell, 215-690-0245
mitchell@nccn.org
www.nccn.org

http://www.pr-inside.com/is-cancer-community-in-alignment-about-r475340.htm

Selling cancer chemotherapy with concessions creates conflicts of interest for oncologists

http://www.healthyskepticism.org/news/2007/Jun.php

[hotandcold]

None of this suprises me , I have tired to contact doctors supposedly interested in researching for the benefit of others health only to hear more or less the same thing , grant funded narrow mindness that ensures a safe income from them while posing as do gooders and pretending to have the publics or others welfare at heart.

This whole problem has literally cost me the last 18 yrs of my life now and resulted in medical anomalie that has me house bound and with no means to prove it ie. without co-operation from the very same instutions that fund research into the sort of areas I believe my condition , if investigated , might be able to help .

http://www.fascia2007.com/

I contacted some people involved in this , even offered to fund myself if I could but not one of them were interested at all or bothered to ask me anything , no doubt in large because of the reasons previously given i.e. MONEY

Skepticsm is of course a tool in science , but where does that tool end and become a weapon if its being used against the very people they claim to be helping in the first place ?

If Einstein or any of those other early pioneers had the same mentality at those so called health carers ( I mean that is why they got into it isnt it ? ) then we'd still be in caves.