How to Save Billions in Healthcare Without Even Trying

showmethecostsHPpicWith the roll out of Affordable Health Care, increasing attention has been focused on the dramatic rise in health care costs. In addition to being a necessity for all Americans, health care is an important economic transaction we all engage in on a regular basis.

During this holiday season, I asked some patients about their on-line and in-store purchasing habits, and the process by which they choose what to put in their “shopping cart.” While need, want and quality are important, not surprisingly, the primary determinant is price.

When asked if they would put products in their “shopping cart”  while shopping online without any attention to price, their reaction is “of course not, that would be crazy.” Of course, if price wasn’t shown (and appeared to be free) they would load it up their “cart.”

When I then asked if they knew who “orders” their healthcare and puts it in their “shopping cart,” most are stumped by the question, as it is rarely framed in these terms. They often make the mistake of thinking it’s the payer (insurance, Medicare) or the recipient (themselves). In reality, it’s we, the physicians, who order their healthcare, place it in their “shopping cart” and then expect it to be paid by a “third party ,” unconcerned and unaware of the cost. And herein lies both part of the origins of the accelerating healthcare cost crisis and a possible solution.

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Common Drugs That Can Change Cancer Survival NOW

Image   A recent New York Magazine front page headline, “The Cancer Drug Racket,” highlighted an investigative report (1) about the increasing costs of cancer drugs in America. This article describes the anger felt by Leonard Saltz, director of G.I. Oncology at Memorial Sloan-Kettering Cancer Center when he was asked to approved an exorbitantly priced a new cancer drug, Zaltrap, very similar to several medications already on the Memorial formulary. This article highlights what I consider to be the tip of an iceberg, the dramatically escalating cost of new cancer drugs that are quickly outstripping the ability of the nation to pay. In this new era of personalized medicine, a few of these drugs may someday markedly improve the survival of some cancer patients. However, the majority of these “promising” drugs often gain approval after “eeking” out a small, though “statistically significant” increase in survival or response in clinical trials but at what cost? A huge price tag that is often associated with significant toxicity. As noted by Light and Kantarjian in a commentary in the journal Cancer this month (2), twelve of the 13 new cancer drugs approved in 2013 carry an average annual price of ~$100,000 while only one has demonstrated improved survival greater than 2 months. Because of the enormous financial benefit to the drug manufacturer, there’s a premium on developing such targeted drugs. Because of the significant shift in the financial incentives as well as the attraction of being at the frontline in cancer drug development, many of my colleagues have left the practice of medicine for more lucrative positions in the pharmaceutical world. Very few medical oncologists who continue to treat cancer patients on a daily basis can afford to practice in an outpatient private practice setting. Why? Because of the lack of affordability and the financial risk to provide these medicines. In my final year in private practice, my monthly pharmaceutical costs exceeded half a million dollars. With reimbursement by insurance companies close to or below cost, as well as delays and denial of payment, it simply became financially unsustainable.

As a result of this new reality, there is the increasing consolidation of cancer therapies into large institutional settings such as hospital-based clinics and specialized cancer centers. Many medical oncologists are leaving private practice for hospital-based positions or are choosing to retire early. In this setting cancer care is BIG BUSINESS. One disturbing trend is the recent announcement of the opening of outpatient cancer treatment centers by non-medical organizations, including a large grocery chain in the Midwest! (3). Yes it’s hard to believe and let me tell you about some of the ramifications. Continue reading

On the Origins of Cancer in the Paradox of Good Health

ImageA recent New York Times article, In Sickness and in Health: a Wedding in the Shadows of Cancer, struck a particularly sensitive chord. It profiled the courageous journey of two of my patients, a husband with advanced pancreatic cancer and his wife with metastatic breast cancer and their preparation for the wedding of their daughter in the face of their battle with cancer. Among the responses of readers, an interesting and common concern stood out, why we continue to have an epidemic of cancer and why have we not dealt with the toxic mix of chemicals in our environment that they assume are a major cause of these cancers.

This perception is widespread. While there is little doubt that there are adverse health effects from these exposures, their role in the origin of the typical “western cancers” (breast, colorectal, prostate, etc.) remains uncertain. Certainly the central role of tobacco in lung cancer and several other cancers is undisputed.

What is most striking is the lack of awareness among the public and health care providers alike about the growing evidence that many non-smoking related cancers may actually be, in part, a direct effect of modern good health.  The marked improvement in maternal and early childhood nutrition has played an important role in the health and well being of modern populations.

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SOY. Is It Bad for Me?

Soy Beans and TofuI get this question almost daily from my breast cancer patients. People are understandably confused. As is the case with other foods, as research evolves, there are changing messages disseminated about their impact on health matters.

So, what information compels you to make decisions in life? The story about soy is the story about the evolution of knowledge about diet and cancer in general, as they say, and here is the rest of the story.

The earliest studies in the 70’s and 80’s indicated that Asian women had lower breast cancer risk than European and American women.  It turns out that many things about the life and culture of Asian women are different beyond their diets. The early thinking about possible connections to lower cancer risk focused on low fat intake and soy. Many in the research community advocated lowering dietary fat and increasing soy intake to reduce breast cancer risk and improve survival. Thus was born a wave of enthusiasm for all things soy.

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Understanding Cancer Risk: The Paradox of Modern Health

ImageIt is important to understand risk and why Americans have a particular difficulty with the issue of cancer risk.

This, in part, reflects a unique American belief that we can have control of all aspects of our lives. As a result, any adverse event may be linked to something “we did or potentially could have avoided.” Many patients desperately seek to understand the underlying cause of their cancer, in the hope that they can reverse or control this and improve their chances of survival. It is important to understand the “randomness” of mutational events that often initiate the cancer process and our inability to prevent all cancers. The message we get from the media and even the medical press is that we eventually will be able to explain every cancer that arises.

This is simply not true. And in many cases, “I thought I did everything right!” does not apply. We cannot necessarily identify any specific trigger or cause of many cancers. I believe the identification of tobacco and cancer risk and other less common exposure-related cancers, like asbestos, has in some ways fueled this confusion, as has the constant media attention to the “latest exciting findings” that link some exposure or dietary factor to cancer. Continue reading

What You Don’t Know about Hereditary Breast Cancer – Part II

Despite what you may have been led to believe, the rise in the incidence of breast cancer in the last 80 years is apparently not due to hereditary factors!

In my initial blog post, I discussed Angelina Jolie’s recent decision to undergo a prophylactic bilateral mastectomy because she was a BRCA1 gene carrier. While many questioned her need for such a drastic approach to prevention, in light of her strong family history and her lifetime cancer risk, it was an understandable and well thought out choice. In this follow-up post, I want to elaborate on an important issue that I had previously raised and feel has been both overlooked and/or misunderstood by the media and many doctors. Simply stated, the dramatic rise in the incidence of breast cancer over the last 80 years has occurred in both the carriers of such breast cancer genes and in all women, in general, in western countries. How can I make such a bold statement?

As is often the case in scientific inquiry, during the course of my research on breast cancer risks, I stumbled upon an intriguing and unexpected finding.

Let me explain.

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Breast Cancer: Having The Gene Is Not Destiny

angelina-jolie-mastectomy.jpeg3-1280x960The recent news about Angelina Jolie and her bilateral prophylactic mastectomy has brought renewed attention to the high risk of women with BRCA gene mutations of both breast and ovarian cancer.

I would agree that Jolie’s decision to undergo surgery was a reasonable choice. It is well documented that bilateral mastectomy is one of the most effective ways to limit the risk of and mortality from breast cancer in women with a BRCA gene mutation, particularly when performed before the age of forty.

However, that’s not all there is to it. While family history can be an important indicator of breast cancer risk, there’s a critical point that often gets overlooked. Jolie’s situation and its extensive coverage have presented a tremendous opportunity for the medical establishment and Jolie to address a commonly held misconception that has potentially dangerous consequences – that the leading risk factor for breast cancer is a gene mutation resulting in a hereditary predisposition to cancer.

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Cancer: Beyond Conventional Therapy

Dr. Barry BoydWelcome to my blog, Cancer: Beyond Conventional Therapy, a place where cancer myths will be debunked, misconceptions explained, and critical information about nutrition, lifestyle, and cancer will be shared. Whether you have been diagnosed with cancer or are simply interested in learning about what preventative measures can be taken to lower your cancer risk, this community will help you understand more about integrative medicine and help you to thrive, not just survive.

I invite you to ‘like’ my Facebook page, follow me onTwitter, join my LinkedIn network, and please visit my website,