tag:blogger.com,1999:blog-11034229.post1692549850007750776..comments2023-07-14T02:53:40.719-07:00Comments on retired doc's thoughts: Oncologists accused of giving chemo.for profit not patient benefitjames gaultehttp://www.blogger.com/profile/05537303135780186926noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-11034229.post-36233932816567883122009-09-29T19:32:06.349-07:002009-09-29T19:32:06.349-07:00AS a AOCNP, currently not working in oncology, I k...AS a AOCNP, currently not working in oncology, I know without a doubt that oncologist give chemo and EPOs or anything else they can inject for profit. I left my last job because I couldn't sleep at night. The doctor should be in jail. As a drug rep told me off the record 70% of oncologist will choose the drug with a higher profit margin, when other less expensive drugs would do just as well.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-11034229.post-81963373656811650492009-08-19T17:11:40.541-07:002009-08-19T17:11:40.541-07:00James, I actually felt the same, I didn't want...James, I actually felt the same, I didn't want to believe that finances influenced oncologists but I have to say different now since I'm a board certified hospice and palliative medicine physician and work closely with oncologists. There are other reasons why (I believe) and I have posted them on my blog. I have two entries you may find intersting, one is entitled "Letting the Doctor Off the Hook" and "Why Don't They Stop Chemo." I to have seen too many dying patients strapped to hanging bags of chemo. Maybe it's the population I'm exposed to and I don't see the other thousands benefiting from chemo. Anyway, thanks for the blog entry and good posts. <br />HospicePhysicianAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-11034229.post-5630384652052291722007-06-19T04:41:00.000-07:002007-06-19T04:41:00.000-07:00I said that I "did not want to believe" that oncol...I said that I "did not want to believe" that oncologists were so driven by profit as to let their treatment decisions be determined or at least strongly influenced by profit.The above letter and other comments I have come across in other blogs unfortunaely makes me accept the idea that that practice has occured more times than "I wont to believe" Say it isn't so , Joe.james gaultehttps://www.blogger.com/profile/05537303135780186926noreply@blogger.comtag:blogger.com,1999:blog-11034229.post-59558672437416618402007-06-18T21:28:00.000-07:002007-06-18T21:28:00.000-07:00The shift, more than 20 years ago, from the instit...The shift, more than 20 years ago, from the institution-based, inpatient setting to community-based, ambulatory sites for treating the majority of the nation's cancer patients has prompted in large part additional costs to the government and Medicare beneficiaries. The Chemotherapy Concession gave oncologists the financial incentive to select certain forms of chemotherapy over others because they receive higher reimbursement.<BR/><BR/>This was first brought to attention at a Medicare Advisory Panel meeting in 1999 in Baltimore. There was a gastroenterologist in attendance who complained that Medicare had cut his reimbursement for colonoscopies from $400 to $108 and how all the doctors in his large, multi-specialty internal medicine group were hurting, save for two medical oncologists, whom he said were making a killing running their in-office retail pharmacies.<BR/><BR/>Typically, doctors give patients prescriptions for drugs that are then filled at pharmacies. But medical oncologists bought chemotherapy drugs themselves, often at prices discounted by drug manufacturers trying to sell more of their products and then administered them intravenously to patients in their offices.<BR/><BR/>Not only do the medical oncologists have complete logistical, administrative, marketing and financial control of the process, they also control the knowledge of the process. The result is that the medical oncologist selects the product, selects the vendor, decides the markup, conceals details of the transaction to the degree they wish, and delivers the product on their own terms including time, place and modality.<BR/><BR/>A joint Michigan/Harvard study authored by Drs. Joseph Newhouse and Craig C. Earle, entitled, "Does reimbursement influence chemotherapy treatment for cancer patients," confirmed that before the new Medicare reform, medical oncologists chose cancer chemotherapy based on how much money the chemotherapy earned the medical oncologist. A survey by Dr. Neil Love, "Patterns of Care," showed results that the Medicare reforms still were not working. It was still an impossible conflict of interest.<BR/><BR/>A patient wants a physician's decision to be based on experience, clinical information, new basic science insights and the like, not on how much money the doctor gets to keep. A patient should know if there are any financial incentives at work in determining what cancer drugs are being prescribed.<BR/><BR/>It's not that all medical oncologists are bad people. It's just that the system is rotten and still an impossible conflict of interest. Some oncologists prescribe chemotherapy drugs with equal efficacies and toxicities. I would imagine that some are influenced by the whole state of affairs, possibly without even entirely admitting it. There are so many ways for humans to rationalize their behavior.<BR/><BR/>There is some innate goodness of people who go into oncology. At the time when most oncologists practicing today made the decision to become oncologists, there was no Chemotherapy Concession. Most of them probably had a personal life experience which created the calling to do battle against the great crab. At the time when people make their most important decisions in life, they are in the most idealitstic period of their lives.<BR/><BR/>The government wasn't reducing payment for cancer care under the new Medicare bill. They were simply reducing overpayment for chemotherapy drugs, and paying cancer specialists the same as other physicians. The government can't afford to overpay for drugs, in an era where all these new drugs are being introduced, which are fantastically expensive.<BR/><BR/>Although the new Medicare bill tried to curtail the Chemotherapy Concession, private insurers still go along with it. What needs to be done is to remove the profit incentive from the choice of drug treatments. Medical oncologists should be taken out of the retail pharmacy business and let them be doctors again.Greg Pawelskihttps://www.blogger.com/profile/13881517358316630729noreply@blogger.comtag:blogger.com,1999:blog-11034229.post-31228544134151258342007-06-18T07:59:00.000-07:002007-06-18T07:59:00.000-07:00I work in the Oncology field and can attest to see...I work in the Oncology field and can attest to seeing first hand how the doctors will prescribe for profit. Look no further than the current Arenesp debacle, and how doctors used EPO's as a main revenue generator. It is no secret in the sales community that ever since reimbursement changed, Oncologist have become business men.Anonymousnoreply@blogger.com