Terra Sigillata

…is the title of a Newsweek article by Jonathan Alter posted online last night that draws more attention to the Medicare restriction on reimbursements for radioimmunotherapeutic (RIT) drugs used to treat lymphomas. Surgical oncologist, Orac, and I have spoken about this issue in the last few days.

Alter admits his bias a bit, as he was diagnosed with mantle cell lymphoma back in 2004 and received RIT. Moreover, Alter’s Newsweek colleague (and SoCal singer-songwriter), Jaime Reno, attributes RIT to his long-term remission.

The article opens as follows:

What if they found a cure for a cancer that afflicts half a million people, but a combination of stupid bureaucrats and greedy doctors kept patients from getting it?

It’s the kind of scenario that seems like the province of conspiracy theorists or alternative-medicine wackos–but is actually happening right now with a proven treatment for certain common types of non-Hodgkins lymphoma, the sixth-most frequently occurring cancer in the United States.

I take a bit of an issue with Alter in that it’s not so much the partial fault of “greedy doctors” as it is the fact that many oncologists in private practice or small hospitals not associated with cancer centers lack the facilities for handling radioactive or “nuclear” medicines like the RIT drugs Bexxar® and Zevalin® (see the erratum below for clarification). But he is certainly spot on in ripping the Centers for Medicare and Medicaid Services (CMS):

You can count the number of truly successful cancer treatments on one hand, and one of them is about to disappear. If there’s any justice, heads will roll at the Centers for Medicare and Medicaid Services (CMS) over it. At a minimum, officials there should be facing some hellacious congressional hearings to force them to reverse a Nov. 1 “final ruling” [CMS-1392-FC] that could doom this life-saver. Ted Kennedy should schedule hearings now.

Alter also brings up a very good point we learned in researching our post the other day:

CMS, the most powerful federal agency you’ve never heard of, has total authority over which treatments Medicare and Medicaid will cover. Smelling weakness in the RIT market, it announced in August that it will reimburse hospitals less than 50 percent for Bexxar and Zevalin. Because hospitals can’t be expected to pick up the other half (the drugs cost more than $25,000), this will mean the effective end of these life-saving treatments.

Even if a wealthy individual wants to pay out of pocket for RIT, it won’t be available, because CMS says it will “terminate the provider agreement of any hospital” that administers the treatment to some patients but not to “Medicare patients who need it.”

Alter does a fabulous job in describing the whole backstory on the potential loss of a truly disease-altering therapy that is among the most effective drugs in producing long-term cancer remissions (I hesitate to use the word “cure” but Alter’s use of it in the title certainly gets one’s attention.).

For other personal discussions, several commenters on Terra Sig came out to describe the impact of RIT on the course of their disease and presented cogent arguments on the cost-effectiveness of this therapy.

Many thanks to the good folks at Patients Against Lymphoma and the Lymphomation blog (Betsy de Parry, Karl Schwartz, and anjou) for the tip on the Alter Newsweek article.


Erratum posted 15 Nov 2007: I was fortunate to have a delightful e-mail exchange with Mr Alter following the appearance of this post. He redirected me to his issue about “greedy doctors” contributing to this issue by saying, that some physicians prefer to keep patients and their reimbursements within their practice rather than send them off to a cancer center with the facilities and credentialing to administer RIT. From his article,

Because most oncologists not affiliated with major cancer centers don’t have that particular board certification or technology, they aren’t likely to recommend that their lymphoma patients go for RIT at a big hospital. If they do, the doctors are more likely to lose patients and reimbursements, because once these oncologists send their patients to a doctor certified to administer RIT, as one specialist told me, “they don’t come back.” Not all of these office-park oncologists are greedy; some have good reasons to prescribe another treatment.

I most certainly agree with Mr Alter on this issue in that private practice/small hospital physicians who withhold RIT in this fashion are indeed guilty of greed.

Also, for the record, Mr Alter notes that he did not receive RIT for his mantle cell lymphoma but instead underwent an autologous stem cell transplant.

We thank Mr Alter for sending his comments and, of course, send him our warmest best wishes for his continued long-term remission.

Comments

  1. #1 anjou
    November 14, 2007

    Thank you so much for doing a second post on the topic!!!

  2. #2 N.B.
    November 14, 2007

    This is just absurd. It’s this kind of ineptitude and bureaucratic garbage that gives weight to the pile of proposed conspiracy theories about government cover-ups, greed, or just bad politics denying people effective treatments for diseases.