Guest guest Posted March 17, 2003 Report Share Posted March 17, 2003 Mon, 17 Mar 2003 15:40:00 -0500 HSI - Jenny Thompson Breaking Even BREAKING EVEN Health Sciences Institute e-Alert March 17, 2003 ************************************************************** Dear Reader, Harsh, toxic, physically debilitating - chemotherapy is a treatment that no one wants and almost everyone dreads. And yet, when the right chemo is administered at the right time in the right amounts, this therapy is capable of controlling cancer cell growth and adding years to the lives of cancer patients. But considering the extreme reactions that chemo often triggers, why would any cancer specialist prescribe this therapy for a patient whose cancer does not respond to chemo? The disturbing answer to that question is enough to make us reevaluate the central role that chemo plays in cancer treatment. ----------------------------- Drawbacks in the details ----------------------------- Cancer patients often receive chemotherapy drugs in the offices of their oncologists. This procedure, now fairly standard, was established in the early 90's to avoid the high costs of administering the drugs in a hospital. The wrinkle that makes this situation unique is that the oncologists purchase the drugs themselves and bill their patients. And the wrinkle that makes this situation a potential problem is that oncologists typically charge patients far higher amounts than they pay for the drugs. This practice even has a name: it's known as " chemotherapy concession. " Chemotherapy has become such a standard of cancer care that virtually all prescriptions for it are covered by insurance or Medicare, so the markups are generally not paid for by patients. The oncologists say they require the additional revenue from selling the drugs to offset the cost of special facilities and staff to administer the drugs. At face value, this would seem to be reasonable. But I'm sure you won't be surprised to find out there's much more to it than that. ----------------------------- Everyone pays ----------------------------- The problem with this " concession " system it that it perpetuates the use of chemotherapy - a problem that can be broken down into three distinct problems. PROBLEM 1: Taxpayers are footing a large portion of the payout that goes to oncologists. According to the New York Times, some estimates put the amount that the government pays at more than $1 billion per year. That's $1 billion more than the actual cost of the drugs. This amount doesn't include the additional totals paid to doctors by insurance companies - totals for which there are no current estimates, although the chance is very good that the burden carried by insurance companies is at least equal to the amount carried by Medicare. And as we've seen so often in the past, when insurance claims rise, our insurance premiums follow with an upward trend that seems to have no ceiling. The Times quotes Dr. Larry Norton, an oncologist and former president of the American society of Clinical Oncology, as saying that he and other doctors are just trying to " break even. " Well, things are tough all over, but don't pass the hat just yet to help your local oncologist squeak by, because according the Medical Group Management Association, over the last ten years oncology has become one of the most lucrative fields of medical practice, largely due to the chemotherapy concession. By some estimates, two-thirds of a typical oncologist's total revenue comes from the concession. ----------------------------- Research suffers ----------------------------- PROBLEM 2: Because oncologists have a strong monetary incentive to prescribe chemotherapy (after all, they're just " breaking even " ), they are less likely to refer patients to clinical research exploring possible cancer cures and less abrasive therapies. Natural Health Line recently interviewed Nicholas Gonzalez, M.D. - a well-known clinical researcher who has treated cancer with nutrition for many years. Dr. Gonzalez is currently recruiting patients for a federally funded study of a cancer treatment based on a nutrition regimen. Complicating recruitment is the fact that many oncologists are reluctant to refer patients and lose the revenue that the chemotherapy concession would bring. ----------------------------- Hard to justify ----------------------------- PROBLEM 3: The most important problem is the way chemotherapy concession affects the treatment of patients. Two years ago, Ezekiel J. Emanuel, M.D. (an oncologist and bioethicist), presented the results of a study that examined the medical records of almost 8,000 cancer patients. Dr. Emanuel found that in cases where chemotherapy was administered in the last six months of life, one-third of the patients suffered from cancers that are KNOWN TO BE UNRESPONSIVE TO CHEMOTHERAPY! In Dr. Emanuel's words, " providing chemotherapy to patients with unresponsive cancers is hard to justify. " Dr. Emanuel used impressive restraint in describing a situation that is deplorable at best, but verges on criminally unethical at worst. It's bad enough to succumb to cancer without also having to endure an abrasive therapy that is virtually guaranteed to have no chance of success - all of this completely without the patient's knowledge, of course. ----------------------------- Two essential questions ----------------------------- The practice of chemotherapy concession is currently being scrutinized by insurance companies and the U.S. Congress. But far more important is the question of quality care for cancer patients. If you or someone you care for has been prescribed chemotherapy, there are two important questions that should be asked of every oncologist: 1) Is this cancer known to be unresponsive to chemotherapy? 2) Is the disease so advanced that chemotherapy would have very little chance of arresting the cancer? Beyond these two essential questions I would also ask: Is there a better way than chemo? By any standard, poisoning the body to help it live is a desperate measure, but undeniably this method has extended the lives of millions. So as harsh as it is, I would never question anyone's personal decision to choose this therapy. But for some, there are better ways to treat cancer. I'm currently reading a remarkable book titled " Living Proof " by cancer survivor Michael Gearin-Tosh who was diagnosed with bone cancer more than ten years ago. He was told by several oncologists that his only chance of surviving even one or two years (at most) was to undergo an intensive round of chemotherapy. He refused, choosing instead a nutritional regimen, and he's alive today. In an upcoming e-Alert I'll have a full report of " Living Proof, " a book that provides a ray of hope for anyone who is willing to wage a fight against cancer on the road less traveled. ************************************************************** ....and another thing Natural supplements can sometimes interfere with the efficacy of prescription drugs, and the opposite is also true, as we see in this question from an HSI member named Karen: " My husband's psychiatrist told him that Prozac affects the liver's ability to utilize herbal medicines such as saw palmetto. He had never heard this before and wasn't able to find anything on the web to corroborate this. Have there been any studies that would prove that statement? " I asked HSI Panelist Allan Spreen, M.D., to help me field this one, and here's his response to Karen: " I'm not familiar with this particular side effect of Prozac. However, bear in mind that Prozac works specifically by enzyme BLOCKING for increased serotonin levels, officially called '...inhibition of CNS neuronal uptake of serotonin' in Physicians' Desk Reference (2002, p.1238). " Nutrient therapies work by promoting the body's ability to produce a desired end result, either by supplying more of the raw materials required, enhancing the enzymes that produce the desired reaction, etc. Drug therapies must block activity of some sort, since they are 'designer' agents created to force a result (unfortunately, blocking something usually impinges on something else that's undesired). If they merely supplied or enhanced a normal situation then they'd be using a mechanism natural to the body, and subsequently the reaction is no longer patentable (read that 'profitable'). " For that reason I'd have no problem believing that inhibition of other natural processes, in addition to the desired one, could easily occur. " Either way, all you need to know to be afraid of Prozac is a partial list of the published KNOWN side effects, admitted to by the manufacturer (only ones labeled as 'frequent' are listed): '...chills...hemorrhage, hypertension...nausea and vomiting...weight gain...agitation, amnesia, confusion, emotional lability, sleep disorder...ear pain, taste perversion, tinnitus...urinary frequency...' (Ibid.) Listing the 'infrequent' side effects would increase the list to positively boring proportions (from five- to ten-fold). " So (though having no proof) yes, I could easily believe the drug could interfere with natural processes. " My thanks to Dr. Spreen for outlining just some of the good reasons to secede from the " Prozac Nation. " To Your Good Health, Jenny Thompson Health Sciences Institute ********************************************************** Sources: " Chemo Versus Nutritional Therapies: Is a Conflict of Interest Compromising Fair Evaluation of Alternative Cancer Treatments? " Peter Chowka, Natural Health Line, naturalhealthline.com, 3/1/03 " Oral Presentation by Ezekiel J. Emanuel, M.D. " Abstract #953, American Society of Clinical Oncology, 5/12/01 " Drug Sales Bring Huge Profits, and Scrutiny, to Cancer Doctors " Reed Abelson, The New York Times, 1/26/03 Copyright ©1997-2003 by www.hsibaltimore.com, L.L.C. 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