Some oncologists exploit the system, make big money, and harm patients

Poison Control

Oncology has a dirty little secret.

Imagine you’re an oncologist. Your patient is succumbing to cancer and will probably lose his battle within a few weeks. Chemotherapy will not prolong his life. Option A: Regretfully inform him that there’s nothing more you can do. Option B: Prescribe a round of chemotherapy and turn an excellent profit.

Option B is chosen far more often than you might think.

Significant poisoning

Last month, a UK review of cancer cases produced shocking results.

In about 600 cases in which cancer patients died within 30 days of receiving chemotherapy…

• 40 percent experienced “significant poisoning” from their treatment
• About 25 percent of the deaths were accelerated or actually caused by the chemotherapy
• One of the co-authors of the study told ABC News (Australia) that in 20 percent of the cases, the decision to administer chemotherapy was simply inappropriate

Professor Ian Olver – CEO of Cancer Council Australia – told ABC that some patients might not fully understand the limits of chemotherapy.

MIGHT not? Any thoughtful (and ethical) oncologist should start from Square One assuming that his patient doesn’t understand ANYTHING about chemotherapy. And it’s HIS job to thoroughly school each patient.

For instance each patient should fully understand that only 10 types of cancer are considered “highly responsive” to chemotherapy. And every patient should fully understand that in many cases, chemotherapy can only be expected, at best, to prolong life by a few months.

And to be completely aboveboard, every patient should also fully understand that oncologists stand to make a nice little profit nearly every time they administer chemotherapy.

Medicare pulled off the gravy train

It’s called the chemotherapy concession (we’ll call it “chemo con” for short), and here’s how it works: Cancer patients often receive chemotherapy drugs in the offices of their oncologists. The doctors purchase the drugs themselves, then bill their patients. Here’s the catch: Oncologists typically charge patients far higher amounts than they originally pay for the drugs.

This is completely legal. It’s a “concession” for oncologists, to offset overhead, and it assumes that insurance companies will pay the lion’s share. But it also tempts oncologists to administer chemo when the drug may not be effective.

When I first told you about chemo con in 2003, it was a real moneymaker. That changed somewhat in 2005 when Congress took Medicare out of the equation. But the con continues for all those other cancer patients whose insurance companies often pay exorbitant sums for cancer treatments. (Yep – this is one of the reasons our insurance premiums are always rising.)

So how pervasive a problem is chemo con? That question was answered by Ezekiel J. Emanuel, M.D., an oncologist and bioethicist. When Dr. Emanuel examined the medical records of almost 8,000 cancer patients, he found that in cases where chemotherapy was administered in the final six months of life, ONE-THIRD of the patients suffered from cancers that are known to be unresponsive to chemotherapy.

Without question, there are many ethical and honest oncologists who don’t line their pockets by exploiting the system. But as long as this system allows a legal free-flow of cash, you can be sure that “significant poisoning” will continue.

Sources:
“Systemic Anti-Cancer Therapy: For Better, For Worse? (2008)” National Confidential Enquiry into Patient Outcome and Deaths, ncepod.org.uk
“Chemotherapy Contributes to a Quarter of Cancer Deaths: Study” Sara Everingham, ABC News (Australia), 11/13/08, abc.net.au
“Oral Presentation by Ezekiel J. Emanuel, M.D.” Abstract #953, American Society of Clinical Oncology, 5/12/01