Monthly Archives: April 2008

Your Money Or Your Life…

There is an article on the front page of this morning’s Wall Street Journal describing the experiences of a Texas woman diagnosed with acute leukemia who had to come up with hundreds of thousands of dollars before she could be treated for her life-threatening disease.


 


The basic premise of the article is that hospitals are no longer going to treat first and bill later.  The rising number of uninsured patients and those who do not pay their bills is reportedly creating an increasingly severe burden on non-profit hospitals, which in the past would have absorbed the costs.


 


I can’t say that I am surprised that this is going on.  I am surprised that it has taken so long for the issue to get attention.


 


The costs of cancer treatment are escalating, in some cases–such as with the newer targeted therapies—substantially.


 


For example, based on some preliminary data that I have seen recently, the Medicare Part B program experienced a 36% increase in expenditures for bevacizumab (Avastin) from 2006 to 2007.  This drug is widely used in the treatment of an increasing number of cancers (it was recently approved, for example in the Continue reading →

Patient Centered Primary Medical Care Gets A Home

There is a quiet, early revolution going on in medicine.  We are beginning to redefine how we provide primary care, moving from a traditional “one on one” patient/doctor relationship to a new model which emphasizes a medical team providing patient focused care.


 


The name of this new model of care is usually referred to as a “patient centered medical home,” or some variation of those words.  The impact of this change—which will take years to better define much less accomplish—has the potential to be enormous and transformational.


 


If done right, this effort has the potential to vastly improve the care we provide our patients, emphasizing prevention as well as more effective, evidence-based primary care medicine when someone develops an illness or a chronic medical condition such as diabetes or heart disease.


 


In my personal opinion, we have the most technologically advanced medical care system in the world.  What we don’t have is the most effective medical care system, based on a variety of measures.  We can provide excellent care, but there is no systematic way to evaluate what we do, there is no way to get needed preventive services to those who need … Continue reading →

Conflicts Of Interest, Tanning, and Your Health

If you want to understand why some of us are concerned about conflicts of interest, you need go no further than an article that appeared in last Friday’s edition of the Cancer Letter.


 


The article, written by Paul Goldberg, goes into great detail to explain why a scientific review on vitamin D, sun exposure and tanning booths which appeared in the New England Journal of Medicine last July may have been influenced by tanning industry funding.


 


The fallout from this conflict, in my opinion, may have substantial negative impact on how we are able to regulate tanning bed use, especially among young women who are putting their health at risk from the adverse effects of articial tanning.


 


The story is not new to regular readers of this blog.  I covered it in July 2007 when the review article first appeared in the New England Journal.


 


Essentially, the article was a review article on vitamin D and its potential role in health and disease.  As I noted at that time and on many occasions subsequently, I admired the depth of the science in the report regarding vitamin D and how it relates to human … Continue reading →

“60 Minutes” And The Cancer Cure

The headline on the CBSNews.com website is loud and clear: “The Kanzius Machine: A Cancer Cure?”


 


The story goes on to promote an interview which is being broadcast this Sunday night on 60 Minutes.  The interviewer is Lesley Stahl, and the interviewee is John Kanzius.


 


Mr. Kanzius’ story is an interesting one.  According to various news stories, Mr. Kanzius has terminal leukemia, which has been under treatment for six years.  His experience with his disease and his treatments has focused him on developing a treatment for cancer that will be more effective and less toxic.


 


Unfortunately, in my opinion, the headline is terribly misleading for patients whose lives may be hanging in the balance.


 


Mr. Kanzius is not a cancer researcher; he’s a retired TV engineer and inventor. His other invention of note was the discovery that exposing salt water to radiowaves resulted in a flame and the production of heat.  Even Mr. Kanzius admitted the process could not be considered an effective energy source, since it took far more energy to produce the radiowaves than was produced by the burning salt water.  Still, the news media could not resist … Continue reading →

Correction to blog posted March 13 on ESAs

As part of a policy review today, I discovered that I had posted an incomplete entry to one of my March 13 blogs describing the outcomes of the Onocologic Drug Advisory Committee meeting for the Food and Drug Administration.  These hearings were held for the FDA to get the committee’s opinions on a number of issuses related to erythropoiesis stimulating drugs, called ESAs.


Because several I have written several blogs on the topic, I thought it important to correct the original blog with the additional information.  I have pasted the exact copy that I had prepared that day, with no futher edits or changes.  You can follow this link to the blog, which was written on 3/13/08 and titled “And Now, The End of the ESA Story (For Today).  I have clearly indicated which material has been added.


I regret this oversight.… Continue reading →

Social Security Disability: Time For An Update?

As I write this, I am returning from a trip to Boston where I had the opportunity yesterday to participate in a hearing hosted by the Social Security Administration. 


 


The topic was “Compassionate Allowance Outreach,” and the issue was how to hasten Social Security disability benefits to patients diagnosed with cancer.


 


Disability is something that many of us don’t like to think about.  In particular, Social Security disability usually means that you are completely disabled and that the disability is long term, as noted in a Social Security booklet entitled “Disability Benefits.”


 


The problem for certain cancer patients is that the benefits they have earned and deserve may not show up until it is too late to be of help.


 


When I started my oncology practice in Baltimore over 30 years ago, I quickly learned as a young physician caring for very sick patients about the problems with Social Security Disability.


 


The forms were long, the paperwork significant, and the time it took to get a benefit determination seemed interminable for my patients.  Medicare didn’t become effective for two years after a patient was declared disabled, which was long after they needed … Continue reading →

Conflicts Are All Around Us

It has been a pretty hectic and busy couple of weeks, with travel, meetings, work, and a short vacation.


 


While I have been otherwise occupied, a lot has been happening.  Unfortunately, much of it hasn’t had to do with advancing the treatment and science of cancer.  Instead, we have learned more than we should need to know about the inner workings of our profession and how research and practice are being supported in the new millenium.


 


My last comments on this blog had to do with erythropoiesis stimulating agents, or ESAs.  These are the drugs which stimulate the production of red blood cells in patients receiving cancer treatment.  Recent evidence, as outlined on several occasions in this blog, suggests that they may be harmful as well as helpful.


 


The FDA hearings a couple of weeks ago led to a lot of press, but at the end of the day there may be some more restrictions put onto the use of these drugs.  However, they will continue to be appropriately available for patients who need them while receiving chemotherapy.


 


The FDA panel did suggest that these drugs not be used in … Continue reading →