Friday, December 30, 2011

December 30, 2011 - More on Out-of-Reach Zevalin

Dr. Vance Esler, oncologist and blogger, posted a comment on my last entry that's worth my cutting and pasting it here:

"Carl, it is an oversimplification to say that oncologists don't refer patients for Bexxar or Zevalin because it isn't in their own personal arsenal. In fact, a fair amount of the treatment is done by the medical oncologists.

Every day medical oncologists take financial risks. We buy and administer expensive drugs, hoping that the insurance carriers will reimburse us enough to cover the costs. We are used to this.

But Bexxar and Zevalin are administered by nuclear medicine physicians, and they are NOT used to taking the financial risks. Furthermore, they don't know how to bill for such drugs, and they are afraid to try.

So no one in our 600,000 person service area offers the treatments. The medical oncologists are not licensed to dispense the drugs, and the people who are licensed are afraid to take the financial risks.

Thus, the medical oncologists are forced to look for alternatives."

Interesting perspective Vance has: that it tends to be the nuclear-medicine doctors who aren't up to speed on administering radio-immunotherapy agents like Bexxar and Zevalin, and are therefore more likely than oncologists to be at the root of the problems these effective medications have had in making their way into the marketplace.  Vance knows a lot more about this than me, so I'm happy to say that I stand corrected.

I find it pretty shocking that his 600,000-person service area in Texas doesn't have a single qualified specialist who's stepped up to the plate to offer these treatments to patients who could use them.

Still, to me this points out, once again, the shortcomings of our free-market, entrepreneurial approach to healthcare funding, that puts doctors in the position of having to assume unacceptable financial risks in order to deliver proven, effective treatments to their patients.  Those who are determined to keep the government out of healthcare funding are continually spouting the line that, left alone, the invisible hand of the market will eventually even everything out.  This is a clear example of just how false such economic dogma is, when applied to cancer treatments.


Vance said...


Allow me to clarify that in my earlier comment, I was only speaking of our area. Radioimmunotherapy is being given in other markets around the country, just not ours. But in our particular market, you won't find them for the reasons I mentioned.

Of course, I am also oversimplifying things a bit. Medical billing is so complicated now, thanks to ALL third parties (government payers included). One small slip in the paperwork can cost a physician tens of thousands of dollars!

But I don't blame the free market and the entrepreneurial approach. The latter is what incentivizes manufacturers to take the financial risks to discover new drugs. And the former is what allows physicians to make the treatments available to their patients in the convenience of their offices near the patients' homes.

The problem now is not that the market is too free. It is that it is no longer free. Medicine is one of the most regulated industries there is! The government now sets the price of everyone's care. Medicare sets its rates, and all the private insurers follow suit.

Now all of them are establishing rationing through refusal to pay for treatments that THEY deem to be unworthy. The payers won't pay for it, and the doctors and patients cannot pay for it.

And this is the way certain treatments, such as Zevalin and Bexxar, start getting scratched off your list of options.

Antic_Hero said...

No wonder why you get so many feedbacks