Although oral tyrosine kinase inhibitors, like Tykerb, offer patients a well-tolerated, conveniently administered alternative to intravenous (IV) therapy, Decisions Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, found that oncologists are not yet ready to use Tykerb as a replacement for Herceptin. Ninety-one percent of surveyed oncologists stated that intravenous (IV) cancer therapies are more profitable than oral therapies. And fifty-eight percent of oncologists say they would favor IV Herceptin over oral Tykerb because administration of IV drugs remains an important source of income for their practices.
http://www.cancercompass.com/cancer-news/1,13054,00.htm
Selling cancer chemotherapy with concessions creates conflicts of interest for oncologists
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 (1).
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.
A joint Michigan/Harvard study confirmed that before the new Medicare reform, medical oncologists are more likely to choose cancer drugs that earn them more money (2). A "Patterns of Care" survey showed results that the Medicare reforms have not solved the problem of variations in oncology practice (3).
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.
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 (4).
The U.S. government wasn't reducing payment for cancer care under the new Medicare Modernization Act (MMA) of 2003. They were 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 (5).
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 force them to be doctors again (6).
1.
http://weisenthal.org/hcfa_1.htm http://weisenthal.org/hcfa_2.htm http://weisenthal.org/hcfa_3.htm
2.
http://content.healthaffairs.org/cgi...tract/25/2/437
3.
http://patternsofcare.com/2005/1/editor.htm
4.
http://jama.ama-assn.org/cgi/content/full/290/2/252
5.
www.medicare.gov
6.
http://ethicsjournal.umc.edu/ojs2/in...e/issue/view/4