A recent study provides evidence that some oncologists prescribe chemotherapy based on their financial reward rather than the medical needs of their patients. This is a continuation of the "Chemotherapy Concession," which came to public light a decade ago. It is a system, unique in the medical world, whereby oncologists can buy drugs at deep discount and then dispense them at the higher, Medicare rate in their offices. In effect, participating oncologists run a kind of pharmacy as a side business (although it is rarely identified as such to the patients). This represents a considerable part of some oncologists' income.

The new study, which appeared last week in the online edition of Health Affairs, will appear in print in July. It showed that when the US Congress tried to reduce Medicare spending in 2003, some oncologists responded by treating a greater number of patients with more expensive drugs to make up for this lost income.

"Many doctors ended up prescribing chemotherapy for more of their patients, to make up for lower prices," commented Reed Abelson, who has long followed this issue for the New York Times. In some cases, doctors bought drugs for 20 percent below the Medicare reimbursement rate. This generated "large sums" (ibid.) that oncologists realized between the wholesale and the retail prices. The authors of the Health Affairs study analyzed the records of over 200,000 lung cancer patients treated between 2003 and 2005. Contrary to expectations, when the Medicare cuts went into effects, doctors wound up giving more extensive (and expensive) treatments. Before the law went into effect, 16.5 percent of such patients received chemotherapy. After the law went into effect this rose to 18.9 percent of patients. Although the authors only analyzed lung cancer, this 2.4 percent difference could be considerable, especially if applied to a substantial portion of the 1,529,460 Americans that are expected to develop cancer in 2010, according to the American Cancer Society (ACS).

TO BE CONTINUED WITH REFERENCES NEXT WEEK.

--Ralph W. Moss, Ph.D.

The Moss Reports is on Facebook (Get Connected)