Follow up on oncologists being paid for promoting pharmaceutical drugs

When the Voice of America host, Dr Gordon Atherley asked me yesterday (July 28th 2014)  what was my experience with the medical profession’s opinion on holistic oncology,  I responded as follows:

To my knowledge, outside of genuine conventional scientists, just about all conventional medical professionals debunk integrative and holistic oncology as ineffective, unsafe, costly and quakery. Consider this piece of allegation from the American Cancer Society.

“The American Cancer Society strongly urges cancer patients not to seek treatment with potentially hazardous metabolic/nutritional therapies, including the Gerson, Manner, and Contreras regimens, in Mexican border clinics. Excessive use of coffee enemas can cause infections, dangerous electrolyte deficiencies, and death, especially when combined with fasting.”

I have visited four times many of these Mexican border cancer clinics and i know what the American Cancer Society is claiming is propaganda, not true. This doesn’t mean there are no abuses or neglect in alternative medicine. But in general, most integrative and holistic health professionals are trying their best to correct and perfect the flawed conventional medical system.

What is clear with the years is that most of the official allopathic oncology authorities either can’t or do not want to understand simple science, let alone are they willing to experiment inexpensive holistic approaches. Too often, their high salaries depend on not understanding Science. I quote from the Journal of the National Cancer Institute:

“…private-practice oncologists typically derive two-thirds of their income from selling chemotherapy” (JNCI 2001;93:491).

And because of the time restriction element, i had to stop there. Had we benefited from more time, i would have continued with the following:

Below, another piece of evidence regarding this money-for-drug-promotion scheme, from the New York TImes.

“Among cancer doctors, it is called the chemotherapy concession. At a time when overall spending on prescription drugs is soaring, cancer specialists are pocketing hundreds of millions of dollars each year by selling drugs to patients — a practice that almost no other doctors follow. The cancer specialists can make huge sums — often the majority of their practice revenue — from the difference between what they pay for the drugs and what they charge insurers and government programs. But some private health insurers are now studying ways to reduce these profits, and the issue is getting close attention in Congress.Typically, doctors give patients prescriptions for drugs that are then filled at pharmacies. But cancer doctors, known as oncologists, buy the chemotherapy drugs themselves, often at prices discounted by drug manufacturers trying to sell more of their products, and then administer them intravenously to patients in their offices. The practice also creates a potential conflict of interest for these doctors, who must help patients decide whether to undergo or continue chemotherapy if it is not proving to be effective, and which drugs to use. Cancer specialists have successfully resisted most government efforts to take the drug concession away, arguing that they need the payments to offset high costs in the rest of their practices. An attempt by the Clinton administration to change reimbursement practices was strongly opposed by doctors, and by George W. Bush, who was then governor of Texas, among others”

Drug Sales Bring Huge Profits, And Scrutiny, to Cancer Doctors  By REED ABELSON (Source)

MORE ON THE FINANCIAL INCENTIVES ONCOLOGISTS HAVE TO PRESCRIBE CHEMO AND RELATED HARD DRUGS

There has been some change as to how much cancer doctors can bill patients.  The change, which mainly affected drugs to treat cancer and its side effects like anemia. But the change did not reduce overall federal spending on cancer care, which actually increased. And cancer doctors say the change did nothing to reduce a larger problem in cancer treatment. Some physicians say that cancer doctors responded to Medicare’s change by performing additional treatments that got them the best reimbursements, whether or not the treatments benefited patients. Those doctors also say that Medicare’s reimbursement policies are responsible. “The system doesn’t value the time we spend with patients,” said Dr. Peter Eisenberg, a cancer doctor in Greenbrae, Calif., and a former director of the American Society of Clinical Oncology. “The system values procedures.” (Source)

The ballooning cost of cancer treatment, one of Medicare’s most expensive categories, offers a vivid example of how difficult it may be to rein in the nation’s runaway health care spending without fundamentally changing the way doctors are paid. Cancer patients and their families play a role in rising costs, too, because they understandably want doctors to exhaust every possible treatment, even if the doctors might serve their patients better simply by talking and listening to them and considering holistic oncology.

 But the unfortunate fact is that  oncologists make money by providing chemotherapy, even when it has little chance of success (See yesterday’s blog on this question). Oncologists naturally dislike telling cancer patients that they have exhausted all available treatments. Ending chemotherapy, after all, means acknowledging that a patient’s disease has become terminal.

“There’s pretty good evidence at this point,” said Dr. Richard Deyo, professor of medicine at the University of Washington and an expert on health care spending, “that there are plenty of patients for whom there’s little hope, who are terminally ill, whom chemotherapy is not going to help, who get chemotherapy.” (Source).

With the new limits on cancer drug profits, some cancer doctors are searching for new income, like performing chemotherapy more often or installing multimillion-dollar imaging machines where they profit when their patients receive diagnostic scans. They are also putting new pressure on cancer patients to make out-of-pocket drug co-payments, which can amount to hundreds of dollars a month. In some cases, they are requiring patients to get injections of certain drugs at the hospital instead of in their offices. Some oncologists say that such changes are necessary because Medicare has not raised its fees for chemotherapy enough to make up the difference. They say they are losing money on Medicare patients and are pressing Medicare to reverse the changes. Unless it does, a number of doctors say they will be forced to close their practices, and cancer patients, especially in rural areas, may not be able to get treatment.

But that representation is not supported by the evidence.   An independent federal commission said last year that the Medicare changes had not reduced patients’ access to care.  (Source). 

The system under which cancer doctors profit on chemotherapy drugs — and so-called supportive care medications, like anemia medicine that is given to counter the side effects of chemotherapy — came into being more than two decades ago. That was when advances in treatment made it possible for patients to receive chemotherapy in doctors’ offices instead of hospitals. Instead of writing prescriptions that patients filled at pharmacies, cancer doctors bought drugs themselves, then administered them to patients and billed Medicare or private insurers for reimbursement. Today, the drugs range from relatively inexpensive treatments like Taxol, a breast cancer drug that costs about $150 a dose, to a new wave of biotechnology therapies like Avastin, a drug for colon and lung cancer that can cost as much as $8,800 a month.

Because the profits on different drugs varied enormously, doctors had an incentive to prescribe medications with the highest margins.  These profits helped drive a vast increase in the amounts doctors billed Medicare for injectable drugs, which soared to $10.9 billion by 2004 from $2.9 billion in 1997. Besides drugs for cancer, the figures include injectable drugs for arthritis and other diseases, though chemotherapy and anemia medications were the largest categories.

The increase in spending, and concerns about the perverse incentives created by the system, caused Congress to modify the reimbursement system to more closely tie Medicare payments to what doctors actually pay for the drugs. Now, drug reimbursement is supposed to amount to only 6 percent more than the average price of the drug paid by all doctors. Because of the change, the overall amount that doctors billed Medicare for injectable drugs fell 6 percent from 2004 to 2005, to $10.3 billion.  Doctors who buy large quantities of medicine can still get big rebates from drug companies, so they can continue to make money on prescriptions.

Private insurers are slowly reducing their reimbursement levels as well, though for most cancer patients they are still paying more than Medicare does. As a result of the Medicare cutbacks, some doctors say they have been forced to refer patients to hospitals for chemotherapy treatment. Because of the complexities of Medicare rules, hospitals can make money providing chemotherapy for patients even in cases when doctors cannot. But it can be a serious inconvenience for people who are very ill and may have a few months to live. Now, oncologists are lobbying Medicare officials and members of Congress to reverse some of the changes and again raise the prices the government pays for drugs.

But Dr. Robert Geller, who worked as an oncologist in private practice from 1996 to 2005 before leaving to become senior medical director at Alexion, a biotechnology company, said that increasing drug reimbursement might raise oncologists’ profits but would not relieve the system’s deeper flaws. As long as oncologists continue to be paid by the procedure instead of for spending time with patients, they will find ways to game the system, however much money they make or lose on prescribing drugs, he said.

“People go where the money is, and you’d like to believe it’s different in medicine, but it’s really no different in medicine,” Dr. Geller said. “When you start thinking of oncology as a business, then all these decisions make sense.” (Source).

So cancer patients NEED TO KNOW THIS, that by prescribing chemo and other related drugs, their oncologists may not have the patient’s best interests in mind, that their first consideration is the money. This perversion of science does not exist in Holistic Oncology. So no wonder that many mainstream conventional oncology experts do not like Holistic Oncology and defames it as a “scam” or “quackery”. These characterizations may be nothing less than conventional oncology expert’s mirror-like projection upon the reality of non-violent, cost-friendly, safe and efficient holistic oncology. (See footnote 1).

STILL OTHER REASONS THAT EXPLAINS CONVENTIONAL ONCOLOGY’S HOSTILITY TOWARD HOLISTIC ONCOLOGY

One of the general causes that explains conventional oncology’s hostility toward integrative and holistic oncology is based on the fact that allopathic medical doctors have gone to mainstream medical schools where they learn little if anything about genuine medicine, in particular about holistic and advanced medicine, nothing on clinical nutrition, let alone, fever therapy, detoxification, bio-physical modalities, psycho-neuro-immunology, exercises,  balneotherapy or, among hundreds of other holistic techniques,  meditation.

Another problem with the holistic approach for the oncology mainstreamers is that it simply does not generate enough cash flow. The pharmaceutical industry for example can not patented a cucumber, or a natural molecule like vitamin C. They can only make alot of money on patented molecules and high-tech medical procedures.

In the HOM book, we substantiate in more details this claim that allopathic-conventional medicine can’t function without patented drugs. This is a problem in the health sciences because most drugs patented are not natural and that the body has a hard time to recognize and correctly process adulterated and synthetic molecules. Hence all of the side and toxic effects that overburden the liver and kidney, two of the major players in the reversal of cancer and other chronic diseases. And to make things worse, allopathic symptomatic medicine will then treat the side or toxic effects and symptoms they create with more drugs, more surgery and other high tech procedures, all of which tends to transform unfavorably the cancer’s micro-environment, which includes the fibroblasts and cancer stem cells, into an inflammatory, unending and costly war zone characterized by genetic depletion, chemo resistance, organ failures, cachexia and death.

This does not mean that drugs and surgery do not have their role. In emergency medicine, they do. But not in chronic diseases like cancer, diabetes, cardiovascular diseases and hundreds of other illnesses. But what most conventional oncologists and medical doctors fail to understand that their “one size fits all” drug for one symptom approach does not work. An illness just does not emerge. Causes and lifestyle must be addressed.  There is a continuum between high blood pressure, a weak immune system, sticky blood, platelet problems, lack of energy and focus, all of these elements must be considered holistically. If they did, there would be fewer diseases and a stronger public finance system. But less money for oncologists and medical doctors and their pharmaceutical, hospital corporations and politician allies. Voilà what can be briefly said on this matter, all of which is important to understand if the patient is to have an “informed decision-making” on these issues.

Footnote One: On the other hand, for those conventional oncologists who are diagnosed with cancer, their opinions tend to me less ideological. In different surveys, most have admitted that contrarily to what they tell their patients, they would not start their treatment plan with chemo. They would first look at innovation and experimental clinical trials and even integrative-holistic oncology before deciding on a medical course of action.

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