Fwd: qotd: Cancer, costs and single payer

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-------- Original Message --------
Subject: qotd: Cancer, costs and single payer
Date: Tue, 21 Jan 2014 13:37:15 -0800
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Physicians for a National Health Program
January 17, 2014
Oncologists call for single payer in leading cancer journal

A feature article published today in the Journal of Oncology Practice
contains an evidence-based appeal by two oncologists, including a past
president of the American Society of Clinical Oncology (ASCO), for their
colleagues to endorse a single-payer health system.

They say they do not believe that the Affordable Care Act, or
"Obamacare," will be able to solve the health care crisis that cancer
patients face.

http://www.pnhp.org/news/2014/january/oncologists-call-for-single-payer-in-leading-cancer-journal

****

Journal of Oncology Practice
January 2014
Why Oncologists Should Support Single-Payer National Health Insurance
By Ray E. Drasga, MD and Lawrence H. Einhorn, MD

Cancer leaves a patient in his or her most vulnerable state not only
physically but financially. Oncologists are in a unique position to
champion the cause of improving access to care for patients with cancer
and easing the financial burden they and their families face.

With ACA now the law of the land, and its retention of the private
insurance industry at the center of the health system, the trend toward
high-deductible health plans, underinsurance, and cost shifting to
patients will almost certainly worsen. 59 Years of private-sector
solutions have failed. There needs to be a major paradigm shift in our
approach to funding health care in the United States.

Because ACA will fail to remedy the problems of the uninsured, the
underinsured, rising costs, and growing corporate control over
caregiving, we cannot in good conscience stand by and remain silent.
Life is short, especially for some patients with cancer; they need help
now. We call on the American Society of Clinical Oncology (ASCO) to
advocate for a single-payer national health insurance program. Our
medical system must be oriented toward caregiving, not toward maximizing
investors' profits.

All of our patients deserve dignity. It is our moral and ethical
obligation as physicians to advocate for universal access to health
care. Oncologists, working in conjunction with ASCO, are well positioned
to educate legislators about single-payer national health insurance. The
time to start is now.

http://jop.ascopubs.org/content/10/1/7.extract

http://org.salsalabs.com/o/307/images/Drasga%20Einhorn%20authors%20proof-edited%20(1).pdf

****

The New York Times
January 18, 2014
Patients' Costs Skyrocket; Specialists' Incomes Soar
By Elisabeth Rosenthal

Many specialists have become particularly adept at the business of
medicine by becoming more entrepreneurial, protecting their turf through
aggressive lobbying by their medical societies, and most of all,
increasing revenues by offering new procedures — or doing more of
lucrative ones.

That math explains why the incomes of dermatologists,
gastroenterologists and oncologists rose 50 percent or more between 1995
and 2012, even when adjusted for inflation, while those for primary care
physicians rose only 10 percent and lag far behind, since insurers pay
far less for traditional doctoring tasks like listening for a heart
murmur or prescribing the right antibiotic.

Oncologists benefit from the ability to mark up (and profit from) each
dose of chemotherapy they administer in private offices, a practice
increased dramatically in the late 1990s. The median compensation for
oncologists nearly doubled from 1995 to 2004, to $350,000, according to
the M.G.M.A. One study last year attributed 65 percent of the revenue in
a typical oncology practice to such payments.

http://www.nytimes.com/2014/01/19/health/patients-costs-skyrocket-specialists-incomes-soar.html

****

The New York Times
January 20, 2014
New Truths That Only One Can See
By George Johnson

It has been jarring to learn in recent years that a reproducible result
may actually be the rarest of birds. Replication, the ability of another
lab to reproduce a finding, is the gold standard of science, reassurance
that you have discovered something true. But that is getting harder all
the time.

Fears that this is resulting in some questionable findings began to
emerge in 2005, when Dr. John P. A. Ioannidis, a kind of meta-scientist
who researches research, wrote a paper pointedly titled "Why Most
Published Research Findings Are False."

His work was just the beginning. Concern about the problem has reached
the point that the journal Nature has assembled an archive, filled with
reports and analyses, called Challenges in Irreproducible Research.

Among them is a paper in which C. Glenn Begley, who is chief scientific
officer at TetraLogic Pharmaceuticals, described an experience he had
while at Amgen, another drug company. He and his colleagues could not
replicate 47 of 53 landmark papers about cancer. Some of the results
could not be reproduced even with the help of the original scientists
working in their own labs.

Given what is at stake, it seems like a moral failing that the titles of
the papers were not revealed. That was forbidden, we're told, by
confidentiality agreements imposed by the labs.

http://www.nytimes.com/2014/01/21/science/new-truths-that-only-one-can-see.html

****

Nature
March 28, 2012
Drug development: Raise standards for preclinical cancer research
By C. Glenn Begley and Lee M. Ellis

What reasons underlie the publication of erroneous, selective or
irreproducible data? The academic system and peer-review process
tolerates and perhaps even inadvertently encourages such conduct. To
obtain funding, a job, promotion or tenure, researchers need a strong
publication record, often including a first-authored high-impact
publication. Journal editors, reviewers and grant-review committees
often look for a scientific finding that is simple, clear and complete —
a 'perfect' story. It is therefore tempting for investigators to submit
selected data sets for publication, or even to massage data to fit the
underlying hypothesis.

Improving preclinical cancer research to the point at which it is
reproducible and translatable to clinical-trial success will be an
extraordinarily difficult challenge. However, it is important to
remember that patients are at the centre of all these efforts. If we in
the field forget this, it is easy to lose our sense of focus,
transparency and urgency.

http://www.nature.com/nature/journal/v483/n7391/full/483531a.html

****

eyeforpharma
Oncology Market Access
By Jill Sackman, D.V.M., Ph.D. & Michael Kuchenreuther, Ph.D

Confronted with unsustainable costs and inconsistent quality of patient
outcomes, the U.S. healthcare segment has been embroiled in a national
debate over healthcare reform. While nearly every division of the
industry has come under fire because of high healthcare costs, one
therapeutic area that has continued to win premium reimbursement is
oncology. Historically, cancer drugs have enjoyed premium pricing and
widespread off-label usage because of their designation for patients
with generally incurable diseases. Furthermore, new drugs have been
rapidly adopted despite weak clinical evidence and overall questionable
value. Thus, it is not surprising that spending on these drugs in the
U.S. has risen at twice the rate of total drug spending in recent years.

http://www.eyeforpharma.com/oncologyusa/numerof-whitepaper.php


Comment: Cancer has become outrageously expensive to manage. A major
factor in the increased spending is the use of high-priced cancer drugs.
The newest drugs are priced at about $10,000 per month - a level at
which coinsurance payments by patients may not be affordable, if the
drug is even covered by the patient's plan.

What is particularly disconcerting is that the science behind these new
drugs is particularly weak. We are paying a lot for drugs that often are
not particularly effective and that frequently make people sick. Many of
these drugs are introduced into the market after showing scant
improvement but were approved because the nominal benefit reached the
level of statistical significance. Factors determining the prices of
these drugs include costs of research and marketing, like other drugs,
but the firms also include "what is a life worth" adjustments -
capitalizing on the grief of cancer patients and their families.

Of course there are therapeutic interventions in cancer that are very
effective, sometimes curative. With today's emphasis on outcomes, should
the oncologists be paid very high fees for the successful outcomes while
being paid little for futile therapy? Of course not. Their incomes
should depend on their provision of professional services regardless of
the prognosis of their patients.

The article in the Journal of Oncology Practice by Ray Drasga and
Lawrence Einhorn explains the rationale of a single payer system - a
rationale that should appeal to all oncologists who have faced the
dilemma of being able to offer only very expensive drugs that provide
unwarranted hope in a futile clinical situation, especially when the
drugs may impose a major financial hardship on the patient.

Imagine a situation in which money is removed from that scenario, made
possible by a single payer system. The patient does not have to consider
out-of-pocket costs when discussing options with her physician. The
physician receives the same income regardless of what clinical course
the patient selects. Clinical decisions are made by the patient using
the best information available, provided to her by her physician. Cost
decisions are made by the public administrator, including negotiated
pricing for cancer drugs, in an environment totally removed from the
clinical scene.

Cancer can be a very cruel disease over which physicians frequently
agonize, acutely aware of the physical and emotional pain of the
patient. We really need a system in which all of our attention can be
devoted to obtaining the very best care for the patient, totally removed
from the "business" aspect of medicine. A well designed single payer
system would do that.