Is Oncology Ground Zero For Reform?

Posted 10/13/15 on The Doctor Weighs In

Brian Klepper

BK 711A few weeks ago, the clinically positive results from the CLEOPATRA oncology trial were released, showing that pertuzumab, when added to docetaxel and trastuzumab as first line chemotherapy, produces an average survival benefit of 15.7 months in HER2 positive breast cancer patients.

That good news notwithstanding, the authors calculated that Genentech’s price for adding pertuzumab to gain one Quality Adjusted Life Year is a breathtaking $713,219. In dry academic language, the authors dropped a bombshell conclusion. “The addition of pertuzumab to a standard regimen … for treatment of metastatic HER2-overexpressing breast cancer is unlikely to provide reasonable value for money spent in the United States compared with other interventions generally deemed cost effective. This analysis highlights the economic challenges of extending life for patients with non-curable disease.”

Drugs only consume about a quarter of cancer costs. The other three-quarters are distributed between physicians, outpatient facilities and hospitals, delivering such lucrative returns that hospitals are rushing to get in on the action. As many as one in four US hospitals are building new cancer centers now. Hospitals’ acquisitions of oncology practices have accelerated, in part because they can charge almost twice as much as physician practices for chemotherapies and other cancer drugs. Continue reading “Is Oncology Ground Zero For Reform?”

“Doctors call for end to five cancer tests, treatments”

Tom Emerick

Posted 4/6/12 on Cracking Health Costs

So reads the headline in a Reuters story on April 4, 2011.

Let’s linger on the notion that they are exposing procedures that are “harmful” yet “routinely prescribed.” Giving harmful care to cancer patients is not rare, but “routine”. The words immoral, unethical, unscrupulous, and venal come to mind.A private task force was led by Dr. Lowell Schnipper, a cancer physician at Beth Israel Deaconess Medical Center. The task force was organized by the American Society of Clinical Oncology.  The goal was to “…to identify procedures that do not help patients live longer or better or that may even be harmful, yet are routinely prescribed.” [Italics mine.]

Continue reading ““Doctors call for end to five cancer tests, treatments””

Book Review – The Emperor of All Maladies: A Biography of Cancer

Brian’s Note: With yesterday’s announcement that Siddhartha Mukherjee’s The Emperor of All Maladies had won the Pulitzer for General Non-Fiction, I thought it might be appropriate to rerun this review from last December 5, 2010.

BRIAN KLEPPER

The opening page of Siddhartha Mukherjee’s The Emperor of All Maladies begins with a quote by Susan Sontag that is so on-point, yet so rare and fresh, that one can’t help being excited by the prospect of what’s to come.

Emperor of All MaladiesIllness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick.

Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

You open the book with great expectations. It is weighty, yes – 570 pages, 100 of which are end notes – but beginning, you immediately find its expansive scholarship wrapped in a writing style so fluid and lyrically engaging that it instantly dispels any hesitancy, and you are captured.

Continue reading “Book Review – The Emperor of All Maladies: A Biography of Cancer”