April 2006 Edition 

Chemotherapy Concessions – Is it Okay for Oncologists to
Make Profits on the Drugs they Prescribe?
© Cancer Monthly, 2006

Every month, Cancer Monthly summarizes the latest clinical results of cancer therapies presented by oncologists, researchers, and other cancer professionals working in over 340 hospitals and research institutions around the world. With this information, patients can compare treatments, have more meaningful discussions with their doctors, and ultimately, make more informed treatment decisions. www.cancermonthly.com

This month we report on the Chemotherapy Concession which allows oncologists to charge more than they pay for chemotherapy drugs and to pocket the difference.  This practice has both clinical and financial implications.

Disclaimer - Please Read: Of course, none of this information in CancerWire is a substitute for professional medical advice, examination, diagnosis or treatment and you should always seek the advice of your physician or other qualified health professional before starting any new treatment or making any changes to an existing treatment. No information contained in Cancer Monthly or CancerWire including the information below, should be used to diagnose, treat, cure or prevent any disease without the supervision of a medical doctor.

Chemotherapy Concessions – Is it Okay for Oncologists to Make Profits on the Drugs they Prescribe?
© Cancer Monthly 2006

A recent study published in the journal Health Affairs “Does Reimbursement Influence Chemotherapy Treatment for Cancer Patients” revealed that the so-called “Chemotherapy Concession” is still in effect and that financial reimbursement has a direct effect on which chemotherapy drugs are prescribed to patients.

A study by researchers from the University of Michigan and Harvard University found that oncologists who were more generously reimbursed prescribed more costly chemotherapy regimens to metastatic breast, colorectal and lung cancer patients.  This study demonstrated that the chemotherapy concession (doctors making profits from prescribing chemotherapy) that brought Congressional attention several years ago is still with us and is still controlling prescribing patterns.

The Chemotherapy Concession

Unlike other doctors, medical oncologists (doctors who prescribe chemotherapy) can profit directly from prescribing certain drugs.  Oncologists can purchase chemotherapy at lower prices than the amounts that the insurance company pays them and then pocket the difference.  This mark-up, which can be as high as 86%, is called the chemotherapy concession.  The Health Affairs study revealed that this type of reimbursement prompts some oncologists to use more expensive drugs with better mark-ups for the doctor.  For example, the study found that for breast cancer patients, a one-dollar increase in a physician’s reimbursement resulted in the use of chemo drugs that cost $23 more.  The authors said, "Although reimbursement seems to have little effect on the primary decision to administer palliative chemotherapy to patients with advanced solid tumors, it appears to affect the choice of drugs used."

Why This Hurts Patients

The Chemotherapy Concession can harm patients in at least three different ways: 1) it creates a potential conflict of interest; 2) it may expose patients to more experimental drugs; 3) it may deplete a patient’s insurance benefits (i.e. drug coverage).

Potential Conflict of Interest - The Chemotherapy Concession gives oncologist other reasons to prescribe chemotherapy and select specific drugs.  Patients must now ask why their doctor is prescribing more and different chemo.  What is behind the decision?  Oncologists insist that money has nothing to do with it.  But, a New York Times article about the University of Michigan/Harvard Study (“Study links cancer doctors’ pay and their treatment”) cites Dr. Craig Earle, one of the study's authors and an associate professor of medicine at Harvard and an oncologist at the Dana- Farber Cancer Institute in Boston.  According to the Times, Dr. Earle stated that despite their insistence that oncologists’ treatment decisions are based solely on what is best for the patient, these decisions are affected by payment policies and other financial influences, including gifts from drug companies. 

Newer Experimental Therapies - Typically more costly chemotherapy drugs with higher reimbursement are those that are newer.  Because the newer drugs have less of a track record in terms of safety and efficacy (i.e. less post approval marketing surveillance), there may be less known about their safety and efficacy.  Therefore, it is possible that a patient may get a drug that is more dangerous to them or less efficacious because of a monetary incentive.

Patient’s Insurance - Someone is paying to put that extra money in the oncologists’ pockets.  Because the costs of premiums are directly related to expenditures, the chemotherapy concession hurts all of us by siphoning money away from patients, employers and payers and into the hands of one class of provider.

What You Can Do

Obviously, a patient wants a clinical decision to be based only on clinical information, not on how much money the doctor gets to keep.  If you are a patient, you should know if there are any financial incentives at work in determining what cancer drugs you are being prescribed.  Ask your oncologist: Why are you prescribing these drugs?  What is their published efficacy and toxicity in other patients with the same cancer?  Do you have any research or financial interests in prescribing these drugs?  Are these drugs a profit center for you in respect to reimbursement?

Obviously you do not want a confrontational relationship with your doctor.  And just because a doctor makes a profit from the drugs they prescribe does not mean that the drugs are inappropriate for you.  A trusting partnership between doctor and patient that facilitates informed consent is the goal for many proactive patients.  Such a partnership, however, may require an understanding of all the factors that lead to a treatment recommendation.

Cancer Monthly provides cancer patients with the results of hundreds of therapies for advanced and metastatic cancers so that patients can compare treatments, have more meaningful discussions with their doctors, and ultimately, make more informed treatment decisions. With Cancer Monthly, patients and clinicians can: 
Access the results of hundreds of different cancer therapies;
Sort by survival rate, side effects, and hospital;
Learn which treatments offered the longest survival;
Discover the side effects experienced by other cancer patients;
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Discover the FDA-approval status of various drugs;
Contact doctors who use specific treatments;
Print out the medical summary of each treatment to share with your own physician.


Chemotherapy Assays

DiaTech Oncology - DiaTech’s New Technology can report to a physician specifically which chemotherapy agent would benefit a cancer patient by testing that patient’s live cancer cells. Drug sensitivity profiles differ significantly among cancer patients even when diagnosed with the same cancer. Knowing the drug sensitivity profile of a specific cancer patient allows the treating oncologists to prescribe chemotherapy that will be the most effective against the tumor cells of that patient. Call (877) 434-2832 for more information. www.diatech-oncology.com

Clinics for Cancer Patients

The Chopra Center - Journey into Healing: Invigorate your mind, body, and soul. Join internationally acclaimed physicians and best-selling authors Deepak Chopra, M.D. and David Simon, M.D., for this signature Chopra Center workshop based on mind-body health as they de-mystify Ayurveda, the ancient healing art of the east, and teach practical tools and techniques to balance your everyday life. Founded on the principle that health is more than the absence of disease, Journey Into Healing explains how and why optimal health is a dynamic, integrated state of balance of the body, mind, and spirit. The next workshop is scheduled for June 29-July 2, 2006 in San Diego, California http://www.chopra.com/sitecontentPage.asp?ContentID=134

Financial Services

Assignable Life Assets was founded in 1989 as an advocacy group to represent and assist terminally ill people in exchanging their life insurance policies for immediate much-needed cash. In the last 16 years, Assignable Life Assets has helped thousands of individuals. If you are looking for a way to help pay for medical care or alternative treatments or just an opportunity to live your life with dignity, Assignable Life Assets may be able to assist you. Phone: (800) 422-1314 http://www.lifeassets.net

Immune Boosting Products

Get Healthy Again.com - This company provides a variety of immune boosting nutritional supplements designed to enhance the immune system. http://www.health-reports.com/cancer-conquest.html

Herbal Fields Supplements - Herbal Fields offers an expanding line of natural, herbal supplements for your personal health maintenance needs, including curcumin. Their site has about 160 various pages of information. http://www.herbalfields.com/curm.html

Polyerga® Plus - Polyerga® Plus is a unique nutritional supplement for supporting the immune system. Although this German-developed spleen peptide technology has been used in Europe and Asia for decades, it is only now becoming available in America. Laboratory and clinically tested to improve key immune system parameters, these peptides help to regulate and stabilize the immune system. http://www.polyergaplus.com

Legal Services

Brain Cancer Misdiagnosis Information Center - Brain Cancer Misdiagnosis Information Center provides information on the frequency of brain cancer misdiagnosis, how you can find out if you have been misdiagnosed, and what you can do about it.  The Center is run by the law firm of Webb, Scarmozzino & Gunter.  http://www.braincancerlaw.com

Cancer Law Center - The Cancer Law Center is comprised of attorneys with experience in helping cancer patients whose disease was made worse because of a delay in diagnosis or whose cancer treatment led to severe injuries. While many people hesitate to contact a lawyer, patients should consider their legal rights if their medical condition was made worse by medical neglect. http://www.cancerlaw.net

Goldberg, Persky & White, P.C. - This law firm (and its predecessor law firms) has been a pioneer in asbestos litigation in the United States. The attorneys of Goldberg, Persky & White, P.C. (GPW) have been involved in asbestos and mesothelioma lawsuits since 1978. Their experienced mesothelioma lawyers participated in the gathering of evidence, such as the testimony of corporate executives and doctors, and the accumulation of corporate documents, that helped create the basis for successfully suing the asbestos industry. GPW has represented thousands of mesothelioma, lung cancer, and asbestosis victims. Because of their involvement in asbestos litigation from the beginning, GPW has a clear understanding of what is required to succeed. In addition to outstanding trial experience, GPW is backed by a large arsenal of corporate documents, depositions, and medical articles with which to vigorously prosecute your asbestos case. http://www.gpwlaw.com/cm

Nutritional Support

Haelan Products offers Haelan 951, an international award-winning, super nutritious, fermented soybean protein beverage. Clinical research and numerous reports from doctors and cancer patients have demonstrated that Haelan 951 helps protect cancer patients from the toxic side-effects of chemotherapy and radiation treatments. In addition, one study found that the soy isoflavone genistein (which is found in Haelan 951) produced greater apoptosis with both chemotherapy and radiation treatments. Apoptosis means “programmed cell death” and it is a goal of most orthodox cancer therapies. Because Haelan 951 is a nutritional supplement, not a cancer treatment, it was used in this study to offset the toxicity of the treatments, not as a cancer therapy. http://www.haelan951.com/

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Copyright 2006 Cancer Monthly