Oncologists call for single payer in leading cancer journal

Physicians for a National Health Program, January 17, 2014

A feature article published today in the Journal of Oncology Practice contains an evidence-based appeal by two oncologists, including a past president of the American Society of Clinical Oncology (ASCO), for their colleagues to endorse a single-payer health system.

They say they do not believe that the Affordable Care Act, or “Obamacare,” will be able to solve the health care crisis that cancer patients face.



Why Oncologists Should Support Single-Payer National Health Insurance

By Ray E. Drasga, MD and Lawrence H. Einhorn, MD

Journal of Oncology Practice, January 2014

Cancer leaves a patient in his or her most vulnerable state not only physically but financially. Oncologists are in a unique position to champion the cause of improving access to care for patients with cancer and easing the financial burden they and their families face.

With ACA now the law of the land, and its retention of the private insurance industry at the center of the health system, the trend toward high-deductible health plans, underinsurance, and cost shifting to patients will almost certainly worsen. 59 Years of private-sector solutions have failed. There needs to be a major paradigm shift in our approach to funding health care in the United States.

Because ACA will fail to remedy the problems of the uninsured, the underinsured, rising costs, and growing corporate control over caregiving, we cannot in good conscience stand by and remain silent. Life is short, especially for some patients with cancer; they need help now. We call on the American Society of Clinical Oncology (ASCO) to advocate for a single-payer national health insurance program. Our medical system must be oriented toward caregiving, not toward maximizing investors’ profits.

All of our patients deserve dignity. It is our moral and ethical obligation as physicians to advocate for universal access to health care. Oncologists, working in conjunction with ASCO, are well positioned to educate legislators about single-payer national health insurance. The time to start is now.




Patients’ Costs Skyrocket; Specialists’ Incomes Soar

By Elisabeth Rosenthal

The New York Times, January 18, 2014

Many specialists have become particularly adept at the business of medicine by becoming more entrepreneurial, protecting their turf through aggressive lobbying by their medical societies, and most of all, increasing revenues by offering new procedures — or doing more of lucrative ones.

That math explains why the incomes of dermatologists, gastroenterologists and oncologists rose 50 percent or more between 1995 and 2012, even when adjusted for inflation, while those for primary care physicians rose only 10 percent and lag far behind, since insurers pay far less for traditional doctoring tasks like listening for a heart murmur or prescribing the right antibiotic.

Oncologists benefit from the ability to mark up (and profit from) each dose of chemotherapy they administer in private offices, a practice increased dramatically in the late 1990s. The median compensation for oncologists nearly doubled from 1995 to 2004, to $350,000, according to the M.G.M.A. One study last year attributed 65 percent of the revenue in a typical oncology practice to such payments.



New Truths That Only One Can See

By George Johnson

The New York Times, January 20, 2014

It has been jarring to learn in recent years that a reproducible result may actually be the rarest of birds. Replication, the ability of another lab to reproduce a finding, is the gold standard of science, reassurance that you have discovered something true. But that is getting harder all the time.

Fears that this is resulting in some questionable findings began to emerge in 2005, when Dr. John P. A. Ioannidis, a kind of meta-scientist who researches research, wrote a paper pointedly titled “Why Most Published Research Findings Are False.”

His work was just the beginning. Concern about the problem has reached the point that the journal Nature has assembled an archive, filled with reports and analyses, called Challenges in Irreproducible Research.

Among them is a paper in which C. Glenn Begley, who is chief scientific officer at TetraLogic Pharmaceuticals, described an experience he had while at Amgen, another drug company. He and his colleagues could not replicate 47 of 53 landmark papers about cancer. Some of the results could not be reproduced even with the help of the original scientists working in their own labs.

Given what is at stake, it seems like a moral failing that the titles of the papers were not revealed. That was forbidden, we’re told, by confidentiality agreements imposed by the labs.



Drug development: Raise standards for preclinical cancer research

By C. Glenn Begley and Lee M. Ellis

Nature, March 28, 2012

What reasons underlie the publication of erroneous, selective or irreproducible data? The academic system and peer-review process tolerates and perhaps even inadvertently encourages such conduct. To obtain funding, a job, promotion or tenure, researchers need a strong publication record, often including a first-authored high-impact publication. Journal editors, reviewers and grant-review committees often look for a scientific finding that is simple, clear and complete — a ‘perfect’ story. It is therefore tempting for investigators to submit selected data sets for publication, or even to massage data to fit the underlying hypothesis.

Improving preclinical cancer research to the point at which it is reproducible and translatable to clinical-trial success will be an extraordinarily difficult challenge. However, it is important to remember that patients are at the centre of all these efforts. If we in the field forget this, it is easy to lose our sense of focus, transparency and urgency.



Oncology Market Access

By Jill Sackman, D.V.M., Ph.D. & Michael Kuchenreuther, Ph.D


Confronted with unsustainable costs and inconsistent quality of patient outcomes, the U.S. healthcare segment has been embroiled in a national debate over healthcare reform. While nearly every division of the industry has come under fire because of high healthcare costs, one therapeutic area that has continued to win premium reimbursement is oncology. Historically, cancer drugs have enjoyed premium pricing and widespread off-label usage because of their designation for patients with generally incurable diseases. Furthermore, new drugs have been rapidly adopted despite weak clinical evidence and overall questionable value. Thus, it is not surprising that spending on these drugs in the U.S. has risen at twice the rate of total drug spending in recent years.


Cancer has become outrageously expensive to manage. A major factor in the increased spending is the use of high-priced cancer drugs. The newest drugs are priced at about $10,000 per month – a level at which coinsurance payments by patients may not be affordable, if the drug is even covered by the patient’s plan.

What is particularly disconcerting is that the science behind these new drugs is particularly weak. We are paying a lot for drugs that often are not particularly effective and that frequently make people sick. Many of these drugs are introduced into the market after showing scant improvement but were approved because the nominal benefit reached the level of statistical significance. Factors determining the prices of these drugs include costs of research and marketing, like other drugs, but the firms also include “what is a life worth” adjustments – capitalizing on the grief of cancer patients and their families.

Of course there are therapeutic interventions in cancer that are very effective, sometimes curative. With today’s emphasis on outcomes, should the oncologists be paid very high fees for the successful outcomes while being paid little for futile therapy? Of course not. Their incomes should depend on their provision of professional services regardless of the prognosis of their patients.

The article in the Journal of Oncology Practice by Ray Drasga and Lawrence Einhorn explains the rationale of a single payer system – a rationale that should appeal to all oncologists who have faced the dilemma of being able to offer only very expensive drugs that provide unwarranted hope in a futile clinical situation, especially when the drugs may impose a major financial hardship on the patient.

Imagine a situation in which money is removed from that scenario, made possible by a single payer system. The patient does not have to consider out-of-pocket costs when discussing options with her physician. The physician receives the same income regardless of what clinical course the patient selects. Clinical decisions are made by the patient using the best information available, provided to her by her physician. Cost decisions are made by the public administrator, including negotiated pricing for cancer drugs, in an environment totally removed from the clinical scene.

Cancer can be a very cruel disease over which physicians frequently agonize, acutely aware of the physical and emotional pain of the patient. We really need a system in which all of our attention can be devoted to obtaining the very best care for the patient, totally removed from the “business” aspect of medicine. A well designed single payer system would do that.