Interesting article in the NY Times 6/12/07 Incentives Limit any Savings in Treating Cancer.
A number of observations were made in the article, many quite accurate and revealing. However the article did not emphasize or give much weight to the tremendous inflation in drug costs over the past 20 years. In the 80’s the average drug cost at most several hundred dollars/dose, in the 90’s the first drug to cost more than $1000/dose (Taxol when under patent if I recollect correctly) was marketed. We now are in the situation where new drugs are costing several thousand dollars/dose with yearly costs approaching $100,000 for a single drug.
In the Times article article it was noted:
“Cancer patients and their families play a role in rising costs, too, because they understandably want doctors to exhaust every possible treatment, even if the doctors might serve their patients better simply by talking and listening to them.” (Medicynical note: Patients are often desperate and somewhat irrational about treatment alternatives. If given a small chance of short term improvement, even 10%, they will opt for the treatment. This, however, is no different today than in the past.)
“In general, oncologists make money by providing chemotherapy, even when it has little chance of success. Oncologists naturally dislike telling cancer patients that they have exhausted all available treatments. Ending chemotherapy, after all, means acknowledging that a patient’s disease has become terminal.” (Medicynical note: As noted above the difficulty is on both sides, patient and doctor. Removing the conflict of interest of physicians will require major changes in the system of reimbursements. We also need to find a way to foster realistic patient expectations and an understanding of the limits of current technology–the media doesn’t help with this as they publicize research results indiscriminately.)
…….”With the new limits on cancer drug profits, some cancer doctors are searching for new income – like performing chemotherapy more often or installing multimillion-dollar imaging machines where they profit when their patients receive diagnostic scans.” (Medicynical view: This is not the whole story. For many years Medicare underpaid support services in physician’s offices. They covered, for example, only a small part of the cost of providing infusion services. Part of the deal Medicare made with physicians when they changed the reimbursement system for drugs was to allow increased reimbursement for necessary support services. I’m uncertain whether some or all of the increase in “physician procedures” noted in the article is this adjustment in Medicare reimbursements. It should be noted also that while we take steps to limit excess profits for the physician there is no similar voiced concern or limit on profits for drug companies–they charge whatever they wish.)
“Today, the drugs range from relatively inexpensive treatments like Taxol, a breast cancer drug that costs about $150 a dose, to a new wave of biotechnology therapies like Avastin, a drug for colon and lung cancer that can cost as much as $8,800 a dose.” (Medicynical note: It would have been refreshing if the author had given emphasis to the inflation in drug costs and the drug industry’s outrageous abuse of patents. Patents give drug companies a government sanctioned monopoly. The quid pro quo of this privilege should be responsible pricing. In reality, drug pricing has little relation to the cost of development; it’s simply whatever the company thinks people or insurers will pay. If the medication is for a serious illness, such as cancer, the sky’s the limit and it’s pay us what we want or die. The major part of cost inflation in cancer care appears to be from patent abuse and price gouging by the drug companies. This added to significant overutilization and/or gaming of the system by physicians leaves us with out of control expenses.)
Our health care non-system needs to address cost inflation, and conflicts of interest as well as provider and administrative inefficiency. I’m hoping to see some awareness of this issue in the up-coming presidential campaign, but as a good medicynic, am not expecting much.