Would You Buy a Used Car From This Man? Part I
Hmm…there’s an eye-catching headline for an oncologist…wonder what they mean by this…
“Payment methods do not seem to affect whether doctors favor chemotherapy over other treatments, the study’s authors said. But once they decide to use chemotherapy, the current payment system appears to prompt some doctors to use more expensive drugs. The authors wrote, ‘Providers who were more generously reimbursed prescribed more costly chemotherapy regimens to metastatic breast, colorectal, and lung patients.”
RED ALERT! RED ALERT! Hit the brakes, Myrtle! Go to DEFCON 1, Commander! Put out an APB for a middle-aged man in a white coat…he is armed with a black tube and small flashlight! Danger, Will Robinson, danger!
So using more costly “chemotherapy” drugs increases the reimbursement to the “provider,” eh? This “study” therefore implies that since using cheaper treatments lowers the revenue paid to an oncology practice, the doctors have a conflict of interest and are biased toward giving “expensive” treatments rather than “cheap” ones. Could there be another possible reason for such a pattern, or is this simply another example of an egregious dereliction of the altruistic spirit the anointed demand in order to save mankind from itself?
“Because there is little evidence that one chemotherapy drug works better than another, ‘the physicians have more control over the agents chosen,’ one of the authors, Joseph P. Newhouse, a professor of health policy and management at Harvard, said in a press review.”
That statement, ladies and gentlemen, raises the hackles of the corporate owners, foreign investors and political comrades of this blog, not to mention all our friends in the olive oil business, if you know what I mean. In rebuttal, let me recite some statistics comparing one “chemotherapy” drug to another in the treatment of the three cancers mentioned in the article, using the outcome of overall survival as a measurement of effectiveness of each regimen, then let the reader decide which treatment they would prefer to take. These statistics refer to patients with metastatic disease for which cure is not possible:
Lung Cancer (non-small cell)
cheap regimen: etoposide/cisplatin; median overall survival (MOS) - 9 months
costly regimen: paclitaxel/carboplatin/bevacizumab; MOS - 17.7 months
Breast Cancer
cheap regimen: cyclophosphamide, doxorubicin, fluorouracil; MOS - 12 to 24 months
costly regimen: docetaxel, vinorelbine, bevacizumab, trastuzumab, et cetera; MOS - at least an additional three months, but we suspect the MOS is on its way to 3 to 5 years based on early data
Colon Cancer
cheap regimen: fluorouracil/leucovorin; MOS - 12 months
costly regimen: oxaliplatin/fluorouracil/leucovorin/bevacizumab; MOS - 22 months
Now if we are not particularly interested in prolonging our life by all means we should ask our oncologist to give us the cheapest anti-cancer treatment available; in fact, using the reductio ad absurdum, in order to avoid wasting our country’s precious financial resources we actually should decline to be treated at all. Now there’s a way to save Uncle Sam some serious dough!
This reminds me of a parable - the story of the publicity crisis at Smiling Joe’s Used Car Lot, but that will have to wait until part two of this post, as I have a plane to catch. Until then:
Stand tall, look ‘em straight in the eye, smile and show ‘em you’re not afraid of anything!
