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“Oh Lord, lead me away from temptation… but not quite yet.

St. Augustine .

The New York Times in its May 9, 2007 issue, published a front page article about oncologists prescribing excessive amounts of anemia drugs to cancer patients on chemotherapy. The statistics are enlightening: the higher the “compensation” or monetary inducements offered to the oncologist-the higher the frequency and dosage prescribed. As they say on the TV commercial, “this drug is not for everyone”.

Inappropriate prescription can actually cause harm, and recent studies showed that inappropriately high doses result in increased mortality.

Response

The American Society of Clinical Oncology distributed a letter to the members.

ASCO Responds to New York Times Article Addressing ESAs for Chemotherapy-Related Anemia

May 10, 2007
Today the FDA’s Oncology Drug Advisory Committee (ODAC) convened to review safety and efficacy data on Erythropoiesis Stimulating Agents (ESA). This issue has been in the news recently in the wake of new studies that have shown possible negative effects from prescribing these agents.

As you may have seen, The New York Times published an article yesterday in advance of the ODAC meeting, which unfairly portrayed the oncology community as being inappropriately influenced by rebates from pharmaceutical companies when prescribing drugs to treat chemotherapy-related anemia.

ASCO has sent a Letter to the Editor to The New York Times in response to this article to express our concern over this mischaracterization, emphasizing the fact that treatment decisions for patients are based on the best available scientific evidence.

Over the past few months, ASCO has alerted members to the FDA’s updated safety warnings for these agents, as well as changes in Medicare coverage for these agents through a series of Member Alerts and ASCO's website. We also will summarize the results from the ODAC meeting in our next Cancer Policy Today. ASCO is working with the American Society of Hematology (ASH) to update the guideline on the use of ESAs in patients with cancer. Access the current ASCO/ASH guideline online at ASCO’s website .

This issue has also gained the attention of Members of Congress. As evidenced by the " Dear Colleague " letter Rep. Pete Stark (D-CA) sent to his colleagues in the House of Representatives yesterday, the issue of ESAs will be a priority for certain Members of Congress moving forward. ASCO will continue its outreach to all Members of Congress, particularly those concerned about this issue, to emphasize that oncologists’ treatment decisions are based first and foremost upon sound clinical evidence and what is appropriate for the individual patient.

If you have any questions, contact ASCO’s Cancer Policy & Clinical Affairs Department at 703-299-1050 or publicpolicy@asco.org .

Complete Disclosure: I am a proud member of ASCO.

Response to the Response

· ASCO makes the same argument that professional people make when colleagues are caught with their hand in the cookie jar: most of us are conscientious, hard working people. Granted. But to turn a blind eye to the corrosive influence of pharmaceutical companies on the use of drugs is denial of the how our health care system “works” on a daily basis.

· ASCO is led by academic clinicians and researchers, whose motivation and dedication is admirable. But many of the rank and file, community practitioners, are not beyond temptation. Most so us aren’t, it’s just a question of ‘how much’. Indeed, the pharmaceutical companies spend more on ‘promotion’ and sales than they do on R&D.

· ASCO is a wonderful organization that promotes cancer research, education, and evidence-based clinical practice. I think it should keep its excellent reputation and avoid getting sullied by entangling itself in the sordid affair exposed by the New York Times.

· As an article in the New York Times of the next day ( May 10, 2007 ) showed, apparently no specialty of Medicine is immune from infectious mammon; psychiatrists are prescribing large amount of psychotropic drugs, many times inappropriately, to people who do not need them .

If the New York Times is going to continue with this series, the next specialties to come into the harsh light being shined on Medicine may be cardiology, orthopedics and radiology. The abuses in these specialties are a well-known secret in the medical community.

As the wheels are coming off our broken health care system, more revelations of waste, abuse, greed and outright criminality are bound to surface. What are we going to do about it?

Dov Michaeli MD, Ph.D