Assembly Line MedicineOctober 2014
By William Faloon
Why Brain Tumor Patients Are Denied Valganciclovir
It is illegal for the maker of valganciclovir to promote it as a treatment for brain cancer. The regulatory system in the United States requires that the maker of a drug conduct extensive clinical trials for each disease a drug claims to treat and then submit the trial results to the FDA for approval.
It is not illegal, however, for an oncologist to prescribe valganciclovir to treat glioblastoma.
The problem is the annual cost for valganciclovir is around $50,000. Many health insurers will refuse to pay this outlandish price. If an oncologist tries to prescribe it for a patient it will not be one of the insurance company’s “recommended regimens,” and the oncologists will likely lose his $350/month stipend because he or she did not adhere to the treatment protocols designated by the insurer.
We fear that 12,000 Americans will continue to die prematurely from glioblastoma every year despite impressive findings showing that valganciclovir could extend the survival times of many of these patients diagnosed with this deadly disease.136
Changing Cancer Care For The Worse
What we are seeing before our eyes are physicians who will give up years of education, creativity, and understanding of the individual patient to instead be directed by an insurance company and rewarded with a monthly stipend of $350 if he or she follows the insurers financially biased “orders.”
The term now used for physicians in such a context is “provider.” They provide the treatment, but are not involved in deciding what treatments to use. Thus, the physician has given up his or her role as “Decider” to become the “Provider.”
The $350/month per patient could possibly be a significant income for the oncologist. Assume that oncologist has 400 active patients and that 100 of them are on the insurers “approved” chemo program. That’s $35,000 per month or $420,000 per year. In most major cities, that’s about what the average medical oncologist makes annually. If the oncologist surrenders his decision making to the insurer, he is doing less work and has fewer worries regarding patient outcome since he was only “following orders.” The insurance company decided on the regimen. Thus, the trade-off to surrender physician autonomy for a substantial monetary reward that involves less stress on the physician becomes an irresistible temptation for far too many highly educated and highly trained medical oncologists.
Another concern is what will the insurer decide regarding the use of supportive care therapy, such as antiemetic and immune protective treatment prior to chemo. What will the insurer mandate regarding which imaging studies can or cannot be done, what laboratory studies are to be obtained and how often, and which immune-augmenting drugs are to be used? Where does the direction of care involving cost cutting stop?
In this newly perverse system brought about by outlandishly high medical prices, why bother using physicians to treat cancer patients? Given this form of cookbook medicine, costs could be further cut by using nurse practitioners or physician assistants to deliver standard care chemo drugs.
Blame The Broken System…Not Just Insurance Companies
A number of health insurance companies are looking into aggressive ways to cut the soaring costs of cancer drugs by seeking to reduce payments to oncologists if they prescribe pricier drugs.
As I wrote earlier this year in an article titled “Unsustainable Cancer Drug Prices,” of the 12 new cancer drugs approved in 2012, 11 were priced above $100,000 a year! Over a hundred oncologists signed a protest letter that concluded that the prices of many of these drugs “are too high, unsustainable, may compromise access of needy patients to highly effective therapy, and are harmful to the sustainability of our national healthcare systems.”137
Just six months after my article was published, we are seeing insurance companies rebel by offering incentives to oncologists to prescribe chemo drugs they perceive as being less expensive. Here is a quote from the insurance company’s oncology medical director:138
“This program—while sharing best practices and evidence-based medicine—also helps to support oncologists who require large staffs to treat these complex patients and provides the practice with enhanced reimbursement to offset the lower fees they receive when prescribing less expensive drugs.”
According to the IMS Institute for Healthcare Informatics, in 2013 the United States spent $37 billion on cancer drugs, which is more than any other category.139 Overall costs for treating cancer are well over $100 billion annually and mounting steadily, according to researchers at the National Cancer Institute. Hospital, diagnostic, and pharmaceutical prices are beyond exorbitant.
A patient under the guidance of the International Strategic Cancer Alliance (ISCA) was recently charged $2,500 for a bone density outpatient test at a prestigious university hospital. The going rate at a diagnostic testing center is around $250. When ISCA responded by threatening to pay for an advertisement in the New York Times indicating this abuse by the university hospital, the hospital drastically reduced their price to this patient (but not to other cash-paying patients).
Still another reason why medical costs are spiraling upwards are large hospitals that are buying out individual oncology practices so higher “hospital” prices can be billed to Medicare, Medicaid, and health insurance companies. When chemo is administered in an oncologist’s private office, the cost is less than compared to a hospital setting. Now hospitals are employing oncologists to make sure patients receive chemo in the hospital’s oncology outpatient facility and billing insurance company’s higher prices, which means you will be paying higher health insurance premiums, along with higher co-pays and deductibles.
The financial coffers of insurance companies are being plundered by the excess charges of hospitals and outrageously high drug prices. Insurance companies are responding by seeking to pay doctors to provide less costly treatments. This is bad news for cancer victims.
It is important to point out that in many clinical oncology settings, the insurance company’s new “recommended regimens” may not be any worse than what patients are getting anyway. Bureaucracies have replaced the “special” physician, the one that comes up with creative approaches and who devours the literature looking for clues to help save his or her patient. Mainstream mediocrity has become the “standard of care” in too many instances and the public apathetically accepts it until they or a loved one is stricken with cancer.
The major factor responsible for the decay and dysfunction of sick care in the US is the powerful pharmaceutical lobby, the health insurance industry, and the burdensome legislation enacted by Congress that stifles innovation in the medical arena. None of these revelations should surprise Life Extension® members, who long ago learned how regulatory strangleholds inflict harsh economic pain, along with needless suffering and death.
What We Are Doing To Save Lives
For over 30 years, we at Life Extension® have relentlessly combatted the high cost of medicine, along with conventional oncology’s less-than-optimal approach to cancer treatment.
We offer two services for members who develop cancer. One is free phone/email access to our cancer advisors. There is seldom a call where we can’t suggest validated ways to improve survival, sometimes as simple as adding aspirin and metformin to conventional treatment. To speak with a cancer advisor, call 1-866-864-3027.
The second option is concierge oversight provided by the International Strategic Cancer Alliance (ISCA). This service has collectively lost us millions of dollars since its inception, but in the process has saved lives and added life-years. The main cost when using the International Strategic Cancer Alliance has been the high hourly rates charged by top-notch oncologists and other personnel involved in developing personalized and creative treatment strategies. New health insurance exclusions may also increase the patient’s out-of-pocket costs when utilizing ISCA’s Personalized Treatment Protocols. To reach out to the International Strategic Cancer Alliance, call 1-610-628-3419.
In this month’s issue, you’re going to read a case history of an advanced stage pancreatic cancer patient who contacted us in time for aggressive innovative therapies to be initiated. Another case history whereby our team of experts saved the life of a very “terminal“ head and neck cancer patient can be read on the next page.
We were also going to publish in this month’s issue an update on the successes we are seeing with breast cancer patients using innovative therapeutic approaches we helped develop. We are deferring that article until at least next month because when we reported on these treatment successes two years ago, the clinic was overwhelmed and had to stop taking new patients. I was informed this clinic should be ready to accept at least some new patients starting around October 15th of this year.
For longer life,