WHERE ARE DEATH PANELS WHEN WE NEED THEM?:

Oncologists are no better arbiters of what is "reasonable" profit or return on investment than anyone else. Their expertise is in prescribing treatments that will be of value to their patients. Yet it is precisely in this area that they have been deficient.

A 2012 American Society of Clinical Oncology (ASCO) panel identified widespread chemotherapy use among patients for whom there was no evidence of clinical value. Despite the lack of evidence supporting the practice and ASCO recommendations against it, chemotherapy is widely used in advanced cancer patients with poor performance status.

While ASCO does recommend treating terminal patients who have good performance status, a new JAMA Oncology study casts doubt on this chemotherapy since it did not improve survival and worsened patients' quality of life. [...]

Cetuximab (Erbitux) was touted at ASCO's 2008 meeting for improving lung cancer treatment. The survival advantage was only 1.2 months and was accompanied by high rates of side effects. Likewise, the FDA approved Erlotinib (Tarceva) to treat pancreatic cancer on the basis of a 0.4 month (12 days) improvement in survival with increased rates of severe rash and diarrhea.

There is no reason, outside of a research study, that oncologists should offer successive rounds of minimally-effective treatments, but they routinely do. Physicians understandably feel an emotional imperative to "do something" when dealing with desperate cancer patients. But that "something" should provide a favorable risk/benefit relationship and not mislead anxious patients. Nothing forces an oncologist to prescribe expensive, ineffective medications with multiple side effects when a cheaper, equally (in)effective medicine, or no treatment at all, will do.

If oncologists limited their prescription of high-cost, low-value, drugs, prices would decline to stimulate sales and would more accurately reflect the drugs' value to patients.

Follow @brothersjudd