Doctors who take money from Pharma Reps (anti-chemo post)
Comments
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I guess I do mind. I seem to have gone off on a rant. Read at your own discretion, Here are just the facts:
DX 2/15/2014, IDC, Right, 1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2-
Surgery 8/8/2014 Lumpectomy: Right
I don't know how to operate the forum profile to make them both show up at the same time (and I don't care) so I went with the most recent. Here's the initial:
In Feb & March of 2014 Doctors ran every test they could on me because I had a pain (undiagnosed still - probable hernia) in my groin area.
The delay in the breast surgery was due to all the time spent having 2 colonoscopies for fear of colon cancer. No colon cancer was found but many polyps were removed during the 2 procedures. For several months I thought my life was over and that I was going to die from colon cancer.
What did I care about a lumpectomy and breast cancer when my life was ending from colon cancer.
I did meet with an MO, once, who literally crouched on the floor in the corner during our meeting. I don't know what he was doing down there but he began to tear up when I spoke of my sister's recent death. He gave me a prescription for Tamoxifen and I never saw him again. He offered up an oncotype test and the next day when I called his office to set it up, his office support staff "didn't know what that was". They had me call someone at a main office who also was unable to assist me and I gave up. After that, I ran from the medical community with little to no adjuvant care until I found this current lump in November 2015.
I hate to be reminded of that darkness.
It only makes me angry at the gastroenorologist for dragging it out for months and never once telling me she was finding no cancer. She led me to believe these procedures were life or death for months.
As long as you're asking, I watched both my mother and my grandfather die of cancer. One went with chemo and the other without. My younger sister died of cancer but she lived in another state and I didn't have to watch.
These are some of the things that helped form my decision of no chemo. Another thing is a picture someone posted here recently of herself during chemo. There are countless hundreds of incidents in my life that have helped form my decision, I could never explain them all.
Shall we chat about the cancer death of my mother's best friend when I was a teenager and how when she was too weak to cook I would stop at her house on my way home from high school to make her lentil soup? How her son & husband were lost without her after her death? Maybe we could chat about what a wonderfully radical, loving, boycott grapes, kind of Northern California girl she was? We could talk about my childhood friend's mom who all the kids called "Lefty" because of her mastectomy. Those daughters of hers, my friends, were adopted because she couldn't have kids. (who will tell the story of your life?)
I am a grown woman and I make my life decisions based on my knowledge and my personal experiences from MY point of view. Please stop looking to me for justification of my choice and just respect it whether you agree or not, as I respect everyone's choices.
I apologize for the rant. The Valium must be wearing off and I am not accustomed to explaining myself. Now, I have to figure out this forum.
PLEASE don't offer any tech support. I may just say wuck it and go get some sherbet.
Sadly, I could never explain them all.
cb
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Darlings,
Thank you all for your support.
This website has given me a lot of great information in their articles which I've found to be both reliable and helpful.
This forum and all of you have been a great support and a font of good info.
Sometimes I think hanging around here in this forum adds to my obsession as well as my depression.
I really need to enjoy my happy life more and not wallow in this illness. (See happy guy above? I could be smiling like that.)
I hope you know how much you've all helped me at this very difficult point in my life. I only wish I could have done the same for you, but as you can see, I've been pretty self absorbed.
I'm going to wake up tomorrow and if my thoughts go directly to cancer, I'm not coming here for support.
I'm getting on with whatever is left of my life.
I'll probably be back in a few years, closer to the end.
Thanks so very much for all your understanding,
cb
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cb123...wow you hit upon a subject that has always bothered me. That is the MO prescribing anti hormones. IMO they just don't know enough about female hormones and this is why they don't test your hormones during the treatment. I think its absurd that they don't see where your hormone levels are when you began treatment and during to see if you are metabolizing the drug properly. I not talking about finding out whether you are menopausal or not. Im talking about when you are menopausal and taking an aromatase inhibitor. IMO there should be an endocrinologist on the team or at least a gynecologist to address this issue. As it stands now the protocol is if you have a recurrence than the treatment didn't work! Cant we do better than this?! PS this is probably in the wrong topic....
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Hey, cb! I was wondering if you ever read about Amy Berman? She is a nurse with Stage 4. She was diagnosed about 6 years ago and refused chemo.From what I understand, she is doing AI's. She is interesting...might be worth a google.
I am thinking of refusing chemo myself. It upsets me that all the statistics are percentages within percentages...and are only in terms of 5-10 year testing. My MO did the Mammoprint for me. With chemo and hormone therapy my "Distant Metastasis Free Survival" @ 5 years is 88%....with Hormone Therapy alone is 76%. These numbers rest inside the 20-30% of recurrence possibility. The other issue I have is what good is it to live if you have to live watching the world go by...which is what I have felt during my recovery...had drain most of the time so activity is limited. So many potential side effects of chemo....and then multiplied by side effects of AI's.
The other thing that is hard to communicate to people is that this aggressive therapy is only treating one little disease in a world of thousands of others that can be contracted in life...and some people have gotten other disease processes from chemo itself or their cancer still recurred.
It is all so much to think about...wonder if one's mind can ever be free from cancer?
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That was an upsetting video to watch about the pharma industry. I will say that that industry is one of the most regulated industries around. I do not think that MOs who are around death every day would ever choose chemo to make money. We all know too many women who have early stage invasive cancer that are told they do not need chemo. These doctors are standing beside us fighting with us. MOs work so hard for their patients. If you don't feel that way, you need to find another MO. A turkey sandwich will never buy influence. If a doctor is a "thought leader" and is speaking to other physicians, it is usually a peer to peer discussion that helps the community and patients who have run out of options. While the pharma industry has brought the majority of the problems on itself, we are all taking life saving or life extending therapies created by them
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It is very upsetting to think a professional doctor can be influenced by a bribe, a turkey sandwich, a speaking engagement for $$$, or a vacation to a conference held in a resort area. Most probably are not, but it is a fact that some do.
An oncologist is well educated and deserves to make a living accordingly. I can't deny or begrudge anyone making a living that is worthy of their craft. 30-60% of an onco's salary is dependent on the chemo drugs they administer and resell to a patient, so I'm sure some do have incentive to keep the ball rolling.
I refused chemo but my onco treats me like a friend or sister. I'm just not a very profitable patient.
xoxMaureen
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Well, my MO told me right off the bat, even before getting my OncoDX result, that based on my pathology she was 90% likely to recommend AGAINST chemo for me. And she doubled down on that once my score came back 16. I sincerely doubt whether a significant part of her income derives from “selling” chemo drugs to patients. She is employed by the cancer centers of a chain of U-of-C teaching hospitals, of which mine is the flagship in the system. Perhaps it’s different in private practice?
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That's been my question too, ChiSandy, and I wonder whether anyone here knows the answer. My onc works for a nonprofit teaching hospital, and is salaried. I assume (but have never asked) that he cannot take direct compensation from product reps.. I suspect it is privately owned oncology practices and for profit hospitals where the big bucks might come into play. Direct compensation or not, it remains that there are both specific guidelines and professional oversight for when and how chemo may be administered.
At our first meeting, my onc educated me thoroughly on how chemo would affect me and my cancer, even taking notes for me (he's been in practice long enough to know that not everything he says comes across correctly, or is retained). His purpose was to prepare me for the decision to come. He was also clear that the oncotype would determine whether he would recommend chemo (he did not). I am grateful for crash course on chemo and its role, and even more grateful that I did not need to partake.
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Very interesting indeed! My MO received over $13K from Amgen for "research". Hmmmm. I see they make Neulasta, which I got after each chemo, at a ridiculous cost. Hmmmm.
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In my opinion this topic is very complex and confusing to most people.
The private practice or community oncologist buys the chemo for patients. They are reimbursed for the chemo they purchased and typically 6% above cost. This pays for the chemo nurses, administering the drug,IV tubing, toxic waste disposal, disposable safety needles, billing staff for the mounds of paperwork and pre authorization, malpractice, rent, mandated software for medical records ect.
These doctors typically loose money when they see Medicare patients because they are reimbursed at cost for the chemo,not the 6% above. Often to treat Medicare patients the cost of providing treatments is greater than Medicare reimbursement. It's actually a sad financial state for these doctors.
If you are receiving treatment at a hospital, the federal government typically pays $6,500 more for treatment than what the private practice makes. This is a reason solo MOs have to join hospital systems/health systems or large groups-it's impossible to make it on their own. These practices go bankrupt. You are right these hospitalMOs are salaried and do not have any financial burdens of running a practice.My MO is a community oncologist in private practice. I was enrolled in a clinical trial via NIH and received Herceptin for free. They are trying to see if there is a benefit for patients who are +2. These patients have some receptors but are not considered positive, therefore insurance will not cover the treatment until there is an indication and a benefit is shown. If your dr came up on that website as being paid for research, it means research. It would say meals or otherwise:-)
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I can say, from experience, that this is not how it works where I am. When you arrive at the chemo lounge front desk, patients arrive carrying bags of their drugs. Why? Because they buy them at their local pharmacies under whatever drug plan their insurance has and then they bring them to the hospital for the infusion. No way for the doc to make a mark-up in that scenario.
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There are a couple of different points with respect to Medicare. The federal budget sequester imposed direct cuts to reimbursements for what Medicare reimburses. This is why many Oncologists had to turn away Medicare patients a few years ago. The reimbursement was reduced to 2% above cost and is now 4.3% above cost for chemo drugs. The oncologist in a private setting will bill for 6% above but will only receive 4.3% above for Medicare patients.
As with most things in medicine the cost is higher to your private insurance company or fed gov't/Medicare insurance with respect to direct cost for treatment in the hospital outpatient setting than it is in the physician office setting. There is a substantial difference in the markup that health plans pay on claims for the payment rates in the hospital outpatient facility compared to the physician office setting. It is true that Hospitals (that now employ many oncologists) have traditionally done very well financially under the "buy-and-bill" system on cancer drugs.
There are many changes happening with regards to oncology and payments. CMS (Centers for Medicare/Medicaid Services) have made reforms to try and reflect value based payment and control costs. They rolled out its payment and practice reform model, OCM,(oncology care model). Medicare is the largest payor in the oncology setting. Private insurance companies are likely to adapt this pay model in the future to cut costs.
Right now providers and hospitals that participate will report clinical and quality data, in exchange they will receive $160 per patient per month. Currently, this monthly fee is paid once a month over 6 months. Oncologists will be responsible for managing the total cost of care and will receive a performance payment for reducing costs. They haven't published what these performance models will look like yet. Medicare would still reimburse a fee for service pay model.
Just like previous posters who worry their oncologists are pushing chemo on them for financial reasons, we could have a reverse situation. Where oncologist are incentivized to reduce costs. Could a patient get a less effective chemo for her cancer because it is cost prohibitive? This type of accountable care model creates an incentive to reduce imaging, ER visits, radiation therapy, ect.
While the current model has flaws, it is kind of scary to think of providers being paid on a value system because the system will be trying to change physician behavior. It could be a huge intrusion in the patient-doctor relationship and the care provided. This is the way things are moving so I guess we just need to keep our knees bent and brace the change
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NovaGirl,
In completing my due diligence on the medical practice in question, I found them to be owned by Mc Kesson. The new MO is in Private Practice owned by the doctors themselves. The difference in the office equipment and décor is glaring. The multi-national drug company's office is state of the art, the private practice, not so much.
I had my final appointment with the old MO yesterday here's how it went:
Thursday, I finally was able to meet the new MO only a couple of hours after meeting with the old MO.
We talked about my history, my current situation and my new test results. I am currently still at stage IIIC – officially, but there are 3 more tests scheduled for Tuesday.
There's also a tumor marker test, CA 27.29, currently showing 183. "Normal" Results < 40 U/ml Generally, levels > 100 U/ml signify cancer (30% of patients have elevated CA 27.29 for 30-90 days after treatment, so wait 2-3 months after starting new treatment to check). I am just 5 weeks out of surgery.*
Both MOs now think there is a distant metastases hiding and that at any moment I will move on to a stage IV diagnosis. I've thought this way from the moment I was told there were 20 positive nodes.
While both MOs still suggest the chemotherapy, the new MO actually listened to me explain my objections. The old MO had that air of authority that some "hot shot" doctors get and just took charge of everything in a way that didn't leave room for my feelings or objections.
The new MO has agreed to the stage IV treatment recommendations without the chemo and I begin Arimidex today. She's ordered up a bone density test and also prescribed a calcium supplement.
She said that she felt I was making an informed decision, and that considering my age, family history, the aggressive nature of my cancer and my feelings about chemo as well as my feelings that I have already been blessed (with more years on Earth than so many other get), that she could agree with my treatment plan.
A few more personal things happened yesterday that made me cry for hours. I took a Valium so I could deal with the day.
My only child's birthday, she called between appointments.
Prince died. He died a young looking 57. I am a young looking 58. I have now lived on this Earth longer than a master musician who I would have gladly given my extra time. Some people don't understand that when someone younger than me dies, not only am I sad for them but I feel especially blessed for the extra time I've been given.
I normally celebrate the day I gave birth with a bottle of champagne. I haven't been able to drink for months since this all began. I prefer to drink daily. So I drank a bottle of champagne. And cried some more.
But today I can move forward. Today there's a plan in place that I can agree with. A plan that allows me to live the rest of my life in any manner I choose. Just like normal people who don't have cancer do. Cancer can become the one chapter it should be and I can now go back to my regularly scheduled life.
Of course the occasional this or that will happen, as in any life. I still have to have a hysterectomy and who knows where that hidden cancer will show up. But overall, I can go on without being handcuffed to the medical community. I can have my life back, I'll just be living with cancer. I'm OK with that.
It turns out that chemotherapy has worked so well for so many of you and I've noticed that as you give your support you give it in a "chemo worked for me" sort of way.
I'm here to say that chemotherapy will not be working for me, I will not be giving it a chance. It is my life, my death, my body, my choice.
I hope my struggle with the medical community and my struggle of being second guessed by almost everyone in the world I've encountered, gives light somewhere to someone else who may be considering skipping the chemo.
It's OK to just say no to chemo. You do not have to blindly follow - you can decide for yourselves.
cb
*The MUGA test that the old MO said was "fine" and my heart was "strong enough for chemo", came back at 55. The new MO called it borderline and low. I hadn't bothered to check, but yesterday when I got home and did check, I too find it borderline and low.
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CB123, I am so glad you found a doc who listened to you and took your concerns seriously. It sounds like you have a plan, and a good plan. AIs can do wonders, I hope they will do that for you and that you will have many years yet (and bottle s of champagne
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Momine,
There you go again, saying just the right thing.
I better head out to the pharmacy and pick up "the new plan" so I can get on with my day.
Thank you for your nice wishes on my behalf.
cb
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Hi Jennie93,
Please, along with the price of the drug, take into account the benefits and side effects.
Just because a doctor may be getting paid to give you that drug doesn't mean the drug is harmful.
This drug may be the perfect compliment to your therapies. I know nothing about it but it may be doing you and your particular version of cancer a world of good.
Each case is individual and should be considered from all angles.
cb
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Cb123, I agree with Momine. I'm glad you found an MO who worked with you and your goals. You made the best decision for you, alongside your MO. I hope the AI knocks any nasty cells completely out and your stage never changes. Hugs:-
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Thanks NovaGirl,
I'm happy too. Little things popping up as I make the paperwork transfer really let me know I made a good choice. I also think that moving forward, when there's a medical referral to be made, I'll put it on hold while I research the physicians in question. This being "assigned" thing just doesn't work for me. Live and learn, right?
cb
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F*ck me!
Spring 2016 - I chose a new MO and told her that I specifically chose her because she didn't take big pharma money (except for $500 worth of free lunch). She said, "Oh no, no. Never." The 2015 results weren't posted yet but here they are:
She knew damn good and well that she took $13,000 just 8 months before we spoke.
Lying bitch from hell. She's so fired.
Here are the 2014 results I used when I chose her:
We do the best we can with the information we have at the time. Lying bitch from hell!
There's a reason people don't trust the medical community, this lying bitch is one of the reasons.
I hope your day is going better than mine,
cb
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Personally, I see a big distiction between the various types of payments. As explained at the link in your original post: "Sometimes, doctors and hospitals have financial relationships with health care manufacturing companies. These relationships can include money for research activities, gifts, speaking fees, meals, or travel."
It appears that the bulk of the money was designated as a "Research Payment". My understanding is that this is money for research, not a free meal or some boondoggle trip to Palm Springs. "Pharma Reps" (members of the drug company sales force) do not control or distribute research payments. Also, such payments do not personally enrich the doctor, because they are typically subject to contracts with the company requiring allocation of the funds to materials, etcetera required to complete a specified research project. An MO who has an active research program may be more likely to be up to date on recent research developments.
By the way, world class researchers and clinicians who are seen as "thought leaders" in their fields are highly sought out by companies as advisory board members and consultants, because of their expertise. Their expertise and knowledge informs research and development strategy, and ultimately benefits patients.
BarredOwl
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I'm still far too angry and feeling betrayed right now to wonder just what sort of research she does, if any. I'm still "cussing" angry.
How will I believe anything she has to say? I no longer trust this woman. I specifically discussed this with her and she lied to my face. Had she been honest, she would have mentioned taking $13,000 from a drug company during our discussion. A dozen companies or more bought her lunch, only Celgene gave her serious money and she knew that as we were having our conversation. My doctor lied to me.
I haven't thought much about this for awhile so I'm not up to date. I'll watch the video again. I made my decision months ago, did my research, found a new MO and put this little nightmare behind me. It's just recurring is all and I have to get to work again.
Apparently, GlaxoSmithKline no longer pays for "thought leaders". I can only imagine companies have to look elsewhere for their advisory board members and consultants.
I know my PCP takes zero dollars for anything from big pharma and he "gets it." We'll just have to work a little more closely together because I'm fed up to here with the medical community right now.
In my mind this whole relationship is a HUGE conflict of interest. When someone grants you research money you cannot help but think kindly of them, favor them above companies that didn't grant you research monies. Why do you think these people pay for so many lunches? To garner good will and curry favor.
cb
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There is another way to go. If drug companies wanted to fund research without the illusion of conflict of interest, they could fund research at non-profits like Cold Spring Harbor.
cb
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So where do you find this info? My MO is also a researcher and, while I happen to not be bothered by who funds him and why, I'd just love to look up his sources.
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Brookside,
There are plenty of legitimate researchers out there. It sounds as if yours openly shared that information with you. Disclosure is a good thing.
Please keep in mind that just like we all have our own different cancers we, most of us have equally personal treatment plans. Your MO is probably doing what's best for you and your symptoms.
I woke up this morning thinking that I was riding a pretty high business morals horse and that doctors are only human. Then it occurred to me that a bribe is a bribe, no matter what you call it. This sort of bribe was removed form the industry I'm in - the mortgage/banking industry. I think it needs to be removed from medicine.
I hope you're comfortable with what you find at Open Payments. Many people are.
Blessings to you all,
cb
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kayb,
I found this private practice MO in a poorer neighborhood where she assists mostly low income patients. She also has offices downtown and in the resort area of our Metro. I like to think that she uses the money for medications to give low income people who can't afford to pay, under the guise of research. Maybe Celgene gave her $13,000 worth of some medication? I have no clue and no desire to find out.
Whatever she uses it for is immaterial to me compared to the fact that she didn't disclose when specifically asked. It's a blatant lie of omission.
I wish her the best with her research but she is not a doctor I can trust.
cb
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I normally use the phrase "Big Pharma", the comedian in this thread was primarily discussing reps as the front men for the companies. Just as the MO listened to me when I discussed my concerns about chemo, she listened to me about my concerns of doctors taking the money. This was not a yes or no question, it was a discussion. She could have said she takes money for research, I could have asked her about her research but that's not what happened.
I imagine that once she was awarded the grant, she was swiftly visited by the company's rep in a congratulatory fashion. If those reps know every prescription a doctor writes, you can bet your butt they know when their own company coughs up 13 grand. The reps are just trying to get paid and working is a system that allows this practice. They do what their big pharma bosses tell them to do.
My next appointment is not until October. I have a feeling that somewhere between now and then, I'll print out this thread and leave it for her at her office while I cancel that appointment.
It's good of you to play Devil's advocate and to support research payments and the medical community in general. I don't care for the current system and will not support it.
cbPS I'm gone for the rest of the day. Please don't look for a swift response, I'm not home.
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In the world of medical research grants, $13k is nothing. It'll buy one small piece of lab equipment or pay for a quarter of a grad student for half a year.
cb123, you wrote I don't care for the current system and will not support it.
I ask this seriously: How do you think most of the medical research that has been done prior to and during our lifetimes (i.e., why we have a longer lifespan than, say, our grandparents) was paid for? Does anyone close to you take simple prescription drugs, like allergy meds or something for hypertension? Who did that research? Might some of it have been done by pharmaceutical companies?
I don't need my providers to pass purity tests in order to provide care to me. Most of them are not private practitioners anyway, but work for corporations - i.e., Big Health Care. BHC has rules about what their employees can and can't do. The docs have a lot less freedom to accept payola than they did 20-30 years ago.
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My views aren't skewed. Reps show up for $20 lunches all the time. Showing up for $13k is a no brainer.
If only I didn't have my hands full with this deadly disease I might find time to direct my thoughts to politics. Do you really want to get me started on big pharma lobbyists?
I do need my providers to pass purity tests in order to provide care to me. I need to trust them.
Sweeties, Look at that link and tell me again how my anti big pharma views are skewed.
cb
Keeping a doctor I can't trust affects me.
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Thanks for the link, cb123. I checked it out and it requires a download, so I'm skipping it for now. As I indicated, my onc is actively engaged in research. He's also an associate prof at the medical school, so I've always assumed his income comes from at least these three separate sources. I'll see him in a couple of months and will ask about how he is paid. As I indicated above, for me, this matters little, but I kind of like to know things, so thank you for raising the issue.
Like a few others, I'd encourage you to chat with your doc about exactly what that $13,000 indicates. You will know precisely why she received the $$$ and why it did not occur to her to mention it, and she will have the opportunity to fully understand your position.
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When trust is absent from a relationship, there isn't a relationship.
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