HSI - Concession Stand

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" HSI - Jenny Thompson " <HSIResearch

 

 

HSI e-Alert - Concession Stand

Wed, 30 Mar 2005 06:59:00 -0500

HSI e-Alert - Concession Stand

 

Health Sciences Institute e-Alert

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March 30, 2005

 

Dear Reader,

 

Imagine sitting down with your doctor to receive the shocking news

that you have bone cancer and only a couple of years to live. Even

worse, he tells you that your life expectancy will be considerably

shorter unless you immediately begin an intensive round of chemotherapy.

 

Then imagine saying, " No thanks; no chemo for me, " and going on to

live for well over a decade.

 

Against the odds, that's what happened to Michael Gearin-Tosh, a don

of English literature at Oxford University. In the e-Alert " Land of

the Living " (3/11/03) I told you about Mr. Gearin-Tosh's remarkable

book, " Living Proof: A Medical Mutiny, " in which he describes the

rigorous nutritional regimen he used to control his cancer.

 

" Living Proof " is not an attack on chemotherapy use, but it offers a

reminder that the need for chemotherapy should always be questioned

because this harsh treatment is sometimes prescribed for cancers that

simply don't respond to chemo. Why? The answer to that question

uncovers a disturbing business aspect of chemotherapy that few

patients ever get a glimpse of.

 

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Offsetting costs

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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 is known as

" chemotherapy concession. "

 

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. And because chemotherapy has become such a

standard treatment, virtually all prescriptions for it are covered by

insurance or Medicare, so the markups are generally not paid for by

patients.

 

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.

 

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Everyone pays

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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, the amount that the government pays

may be 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 often seen, when insurance claims

rise, our insurance premiums follow.

 

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.

 

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Research suffers

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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

clinical researcher who has treated cancer with nutrition for many

years. When Dr. Gonzalez was recruiting patients for a federally

funded study of a cancer treatment based on a nutrition regimen,

enrollment in the trial was complicated by the fact that many

oncologists were reluctant to refer patients and lose the revenue that

the chemotherapy concession would bring.

 

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Hard to justify

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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 final 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. "

 

I'd say that's putting it mildly.

 

Specific types of cancer that are not responsive to chemotherapy

include: pancreatic, melanoma, hepatocellular, renal cell, and

gallbladder. If you are diagnosed with one of these cancers and are

prescribed chemotherapy, it's time for a second opinion.

 

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....and another thing

 

" A rose hip by any other name... "

 

Vitamin C terminology is the subject of a recent e-mail, signed by HSI

members Ginger and Larry. G & L write:

 

" It seems to me that someone is missing the fact that vitamin C is NOT

the exact same item as ascorbic acid, ever though it is often measured

that way. The entire complex of C includes elements that Jonathan V.

Wright and others have written about often and I feel, as a

chiropractor learning as much as I can from the big guys about

nutrition, that there is something there that should be taken into

account. Comments? "

 

It's true that the terms " vitamin C " and " ascorbic acid " are often

used interchangeably, but shouldn't be. In the e-Alert " Attack of the

Vapors " (1/6/04), here's what HSI Panelist Allan Spreen, M.D., had to

say about ascorbic acid:

 

" This is the standard form of vitamin C. Calcium ascorbate is one of

the salt forms of the nutrient (as opposed to the acid form). It is

usually synthetic, as are other forms, such as sodium ascorbate,

magnesium ascorbate, etc. It tends to be bitter, while ascorbic acid

is sour. "

 

And on the natural vs. synthetic forms of vitamin C, Dr. Spreen again:

" The synthetic vitamin C molecule is chemically identical to natural

forms. The difference arises in other nutrients that accompany the C,

such as bioflavonoids, which make the C more effective. That's not to

say that I don't prefer natural; it's just that it's very hard to come

by, and extremely expensive. "

 

" Attack of the Vapors " provides a compact but thorough look at vitamin

C, courtesy of Dr. Spreen, and can be easily found by going to our web

site (hsibaltimore.com) and using the " Search the e-Alert archives "

feature.

 

To Your Good Health,

 

Jenny Thompson

Health Sciences Institute

 

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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

 

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