April 23rd, 2008 by Dr. Val Jones in Expert Interviews, News
Tags: Cancer, Medicare, News, Oncology, Radiology, Research, Technology
5 Comments »
Imagine that you were diagnosed with cancer, and were told that you had one of two treatment options: 1) you could receive a one time dose of a medicine that will go directly to the tumor cells and kill them only, having very few noticeable side effects or 2) you could undergo months of exposure to toxic chemicals that will kill the tumor cells and many other healthy cells as well, resulting in hair loss, bowel damage, nausea, and vomiting. Which would you choose?
Unfortunately, choice number one may no longer be an option for lymphoma patients due to government funding cutbacks, and the development of such treatments for other cancers is in jeopardy as well.
Radioimmunotherapy (RIT) is a relatively new approach to cancer treatment, new enough that the government is having difficulty categorizing it correctly. (RIT involves targeting cancer cells with special antibodies that carry tiny, lethal radiation doses to individual cells.) In fact, drugs like Bexxar and Zevalin have been misclassified by CMS as “supplies” rather than medications, and so the reimbursement allowed doesn’t come close to covering the cost of the therapy. Although there are many new targeted therapies under development, investors are worried that the drugs will never be used in patient care because the country’s number one payer (Medicare) is unwilling to cover their costs. Other health insurers often follow the government’s lead when it comes to treatment coverage policies. If no one will pay for the cost of the drug, then ultimately no one can afford to make it available.
Similar funding problems are beginning to limit access to diagnostic nuclear imaging modalities like PET scans, PET CT, cardiac SPECT scans, and bone scans. Reimbursement levels that do not cover the cost of the imaging drugs means that facilities cannot afford to offer these diagnostic technologies to patients, and centers are slowly reducing the number of tests they offer. Nuclear imaging studies are often critical in diagnosing heart problems, infections, and early detection of cancer. Senator Arlen Specter had his cancer recurrence diagnosed at the very earliest stages thanks to PET scanning technology. Early treatment offers him the best possible prognosis, but he is in a dwindling group of people who have access to this imaging modality.
I spoke with Dr. Peter Conti, professor of radiology at the University of Southern California, and former president of the Society of Nuclear Medicine, from Spain this week – as he is attending the 6th International Workshop for Nuclear Oncology, a lymphoma conference where the crisis in reimbursement for targeted cancer therapies is being discussed, along with exciting advances in treating patients with lymphoma. The two different RIT drugs (Bexxar and Zevalin) for non-Hodgkin’s lymphoma are in jeopardy of not being available to Medicare patients due to proposed cuts in reimbursement. Recent plans to cut payment for these drugs have been halted by a temporary moratorium from Senator Kennedy. Here’s what Dr. Conti had to say:
“Let’s face it, lymphoma is not as high profile as other cancers such as breast, colon, or prostate. However, we’ve found a fantastic treatment option for it, and there are implications for the more common cancers, but that treatment option is being denied to lymphoma patients because facilities cannot cover the costs of offering it. I’d like the entire cancer community to rise up in support of lymphoma patients so that Congress will tell Medicare to fix the funding problem. If this doesn’t happen, it’s only a matter of time until novel RIT treatments are no longer an option and we’ll be stuck in the dark ages of non-specific chemotherapy and radiation treatments that harm the good cells with the bad. Personalized, targeted therapy is the future – and we’re missing the opportunity to further develop these novel therapies due to budget cuts.”
I reached out to the current president of the Society of Nuclear Medicine, Dr. Alexander J. McEwan, for comment:
“Molecular imaging offers critical tools for the early detection, diagnosis and treatment of many life-threatening diseases, including cancer. SNM recommends that CMS establishes appropriate reimbursement for all forms of nuclear and molecular imaging and radioisotope therapies at levels that allow optimum access and improved outcomes for all patients.”
Denial of RIT to lymphoma patients may be the first sign of a new trend limiting the development of high tech therapeutic innovations. Will America’s research engine run out of gas before we figure out how to treat cancer without side effects? Should we buy one more tank to get us over the crest of the targeted therapy hill? This is a judgment call that affects all of us at a time of great need and limited resources. What’s your take?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 20th, 2008 by Dr. Val Jones in Health Tips, News
Tags: Medical Ethics, News
3 Comments »
I just discovered this wonderful non-profit organization devoted to rating the quality of the journalism behind health news reports. Health News Review was founded by Gary Schwitzer, a journalist devoted to consumer empowerment through accurate, spin-free health reporting.
The fun part of this website is that if you see a health segment on Good Morning America, the CBS Evening News, or other TV or major media outlet you can check with the experts at Health News Review to find out if the information you heard was accurate.
Here’s an excerpt from a recent review of a news story that was reported in an irresponsible manner:
This story about a spa-based treatment for reduction of adipose deposits provided little viewer education. Its sole purpose appeared to be as a hook for a more in-depth broadcast which was to occur in that night’s prime time programming. It did not inform viewers about lipo-dissolve in a balanced way or in a manner that would allow them to understand the likelihood of having the adverse outcomes.
The story did not discuss the quality of the evidence available supporting this treatment as effective or ineffective. It contained only anecdotal examples about lipo-dissovlve gone bad. However – this is inadequate information on which to base a decision, even a cosmetic one. Although the women interviewed had adverse effects from the treatment, the story gave no indication of whether these outcomes were exceptions or were the rule.
The approach followed a typical TV news formula: promote something as “sweeping the country…new phenomenon…hottest thing since Botox… reportedly tens of thousands of procedures completed”, then slam it as expensive and unsafe.
Where was the shoe leather journalism to hang some facts on those bones? Why did they have to say “reportedly” tens of thousands of procedures completed? Reported by whom? What did ABC’s own investigation find? Were any trials done? What were the quantifiable benefits and quantifiable harms?
Maybe that evening the ABC 20/20 program answered some of these questions. But for the viewers up early (and possibly not staying up for the 20/20 program), the morning program was a shoddy tease.
If the Health News Review gains enough momentum and recognition, maybe we can raise the quality of health journalism on a national basis. Fear of exposure of shoddy journalism could pressure the media to do a better job of giving us accurate and trustworthy information. Here at Revolution Health our medical experts are doing their best to clarify and comment on the news for you in their blogs. Don’t believe everything you hear on television… if something sounds too good to be true, check it out with the Health News Review or Revolution Health experts to get to the bottom of things.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 17th, 2008 by Dr. Val Jones in News
Tags: Family Medicine, Relationships
3 Comments »
Most doctors are drawn to a career in medicine in large part because they sincerely wanted to help people, and most patients seek out doctors because they want and need help. Yet here we are, wanting to help (doctors) and needing help (patients), and somehow we’ve become disconnected and dissatisfied.
To take the pulse on how patients perceive their current physician relationship, Revolution Health offered this poll on our homepage (this is a sample of 642 respondents):
Q: Are you attached to your doctor?
- Yes, very much so – 24%
- Somewhat – 21.9%
- Not really – 20.4%
- Not at all – 33.5%
There are two ways to look at this, I suppose. The “glass half full” camp might say that 45.9% of people are very much or somewhat attached to their doctor, and that means that a large minority of folks are in a doctor-patient relationship that is meaningful to them.
The “glass half empty” perspective would suggest that 53.9% of people have no perceived personal caring physician in their lives.
I don’t know how people would have responded to such a poll 50 years ago, but I have a feeling that it would have skewed much higher towards the “very attached” end of the scale.
I know that this poll is limited in its scope and significance, but are you surprised by the results?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 17th, 2008 by Dr. Val Jones in News
Tags: Cancer, News, Plastic, Research
No Comments »
I first became aware of the potential link between a chemical found in some plastics (bisphenol A) and health effects in humans a little more than a year ago. I was concerned enough by the preliminary data collected by the NIH to blog about it, and it seems that many others are voicing concerns as well.
In fact, Canada has decided that the evidence is sufficient to label the chemical “dangerous” and will be announcing this shortly:
In Canada, the Globe and Mail newspaper said the Canadian health ministry was ready to declare BPA a dangerous substance, making it the first regulatory body in the world to reach such a determination. The newspaper said the ministry could announce the decision as soon as Wednesday.
Environmental activists long have warned about health concerns regarding the chemical. They praised the draft findings of the National Toxicology Program, which cited more potential worries about the chemical than did a panel of experts that advised the program last year.
At this point we don’t have enough information about how the chemical impacts humans to be sure of its level of risk. But what we do know is that:
1. The chemical is ubiquitous (most Americans have trace amounts detectable in their urine).
2. Animal studies appear to have demonstrated a causal relationship between bisphenol A and fertility, behavioral, and immunologic disorders in rats.
3. Human breast cells exposed to bisphenol A in a Petri dish developed a more aggressive form of cancer.
4. There is a plausible biologic mechanism by which the chemical could exert clinical, endocrine-mediated effects.
For these reasons, I think we should certainly view bisphenol A with suspicion. I will continue to follow the research with interest and concern.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 17th, 2008 by Dr. Val Jones in News
Tags: Breast Cancer, Cancer, News
3 Comments »
My friend (and occasional guest blogger here at the Voice of Reason) Dr. Avrum Bluming just co-authored an eye-opening exposé of breast cancer risk factors and how they’re overblown for media purposes. This article was published in the Los Angeles Times today. Here is an excerpt:
We now have a fat file folder of all the studies we could find that have reported an association between some purported risk factor and breast cancer. Of these, the ones that got the most attention were three Women’s Health Initiative reports. In 2002, investigators found an increased relative risk of 26% from using combined estrogen and progesterone; in 2003, it was 24%; and in 2004, the relative risk from using estrogen alone was minus 23% (suggesting it was protective against breast cancer).
To put those findings in perspective, consider these published studies showing the increased relative risk of breast cancer from:
* eating fish: 14%
* eating a quarter of a grapefruit a day: 30%
* gaining more than 33 pounds in pregnancy: 61%
* being a Finnish flight attendant: 87%
* being a Dutch survivor of childhood famine: 201%
* using antibiotics: 207%
* having a diagnostic chest X-ray: 219%
* being an Icelandic flight attendant: 410%
* using an electric blanket: 630% (but only if you are a black woman who used it for more than 10 years but less than six months in a given year).
Why was there no call for Icelandic flight attendants to quit (or transfer to Lufthansa), for black women to use electric blankets for more than six months a year but only for nine years, for labeling antibiotics as carcinogens? Because these findings, which were improbable to begin with, were never replicated. In contrast, the increased relative risk of lung cancer from smoking is consistently between 2,000% and 3,000%. That’s a finding that means something.
Unfortunately, good news doesn’t travel as fast as fear does. In 2006, the Women’s Health Initiative investigators reanalyzed their data and found that the risk of breast cancer among women who had been randomly assigned to take hormone replacement therapy was no longer significant. Women assigned to take a placebo but who had used hormone replacement therapy in the past actually had a lower rate of breast cancer than women who had never taken hormones.
This reassuring but non-scary news did not make headlines…
To read the rest of the fascinating article, click here.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
