Interesting Conversation w/ Oncologist

Betsydoglover · May 2006

Hi all -

I am not trying to call all the anti-chemo activists out of the woodwork - have to say that while I hated it it seems to have saved my life so far.

But.......... I got into an interesting discussion with my oncologist today. She went to a meeting where some other local (DC area) oncologist was raving about oxaliplatin. But why was he raving? Cuz you know you get to give magnesium and calcium and the infusion time alone is a great financial benefit to your practice! Oh my God as they say! She was outraged, but before she was able to say anything, this guy went on to say that 5FU was better than Xeloda because over the course of treatment, being an infusion, you would see patients more frequently and thus collect more dollars!

Yikes! I am so glad my doc is disturbed by this. And she believes this isn't the majority opinion, but as she says "It is definitely out there!". And, she believes that some chemo regimens from some doctors may have a financial motivation behind them as much as a medical motivation! (Scouty I can hear you talking about the price of drugs now!) The thing is - I am not starting a 5FU vs Xeloda war, but 5FU is given IV in doc office / infustion center etc. Xeloda is a prescription drug. Whole different payment vehicle and the Xeloda payment vehicle does not include the oncologist.

I hate to be so cynical. But, I love my doctor and I am happy to have such a frank conversation which she basically initiated based on a minor comment of mine.

We have to look out for ourselves!

Take care,
Betsy

terril · May 2006

These chemo drugs are money makers. I am on CPT-11, 5-fu and avastin. Every time I get a treatment, it is around $10,500. Avastin alone is about $5,000 a pop. I have heard oxlyplatin is $15,000 a pop. Is this really true? Incredible!!! Terri

nanuk · May 2006

terril said:
These chemo drugs are money makers. I am on CPT-11, 5-fu and avastin. Every time I get a treatment, it is around $10,500. Avastin alone is about $5,000 a pop. I have heard oxlyplatin is $15,000 a pop. Is this really true? Incredible!!! Terri

It's true..as Emily would say, follow the bucks..but I would think that the profit motive would only apply to those Oncs in private practice. Bud

midnte0708 · May 2006

Hi Betsy,
Thanks for sharing. This confims what I had suspected. Then makes me wonder if doctors steer patients to chemo alone when they may be eligilbe surgical candidates or eligible for a different beneficial prodedure (chemo probably costs more than surgery in the long run.)
Sue

Betsydoglover · May 2006

terril said:
These chemo drugs are money makers. I am on CPT-11, 5-fu and avastin. Every time I get a treatment, it is around $10,500. Avastin alone is about $5,000 a pop. I have heard oxlyplatin is $15,000 a pop. Is this really true? Incredible!!! Terri

There seems to be this $15,000 rumor about oxaliplatin. While it is expensive, at least in my case (and I am in DC where things are not exactly cheap), my oncologist billed $4000 for oxaliplatin per treatment and the insurance network agreed amount was closer to $2500 - so the latter is what was actually paid for that particular drug (additional charges of course for magnesium etc and infusion time). So this is all expensive enough, but if anyone is really being charged $15,000 for oxaliplatin drug alone then they are probably being "ripped off"! (My oncologist also told me that Stage III folks on FOLFOX typically get lower doses of oxaliplatin (which should therefore cost somewhat less per dose), although more treatments.)

Betsy

shmurciakova · May 2006

Well, this is indeed interesting. I like to believe that doctors have the best interest of their patients in mind, but.....when I had surgery for my two lung mets that were removed in October of 2004, my surgical oncologist (who also removed a tumor from my liver prior to this), told me that there was no benefit in having chemo after the procedure as I would be NED at that point. With only two nodules, there was not statistical benefit to the chemo, so I elected not to have it. I am quite sure, however, that had I been here at home my oncologist would have had me on chemo. When I told her the thoracic surgeon and the surgical oncologist agreed that I did not need chemo, there was this long pause.....and then she goes "Well, I guess it is better to save the chemo in case you ever need it in the future.."
I did not think anything of it at the time, but now I wonder if somewhere in the back of her mind she was not thinking of the lost money during that pause!

Also, once I asked my oncology nurse why she chose oncology rather than some other form of nursing and she came right out and told me it was because of the money! She said that working for a private oncolgy practice paid big bucks.

-Susan.

NanD · May 2006

Sorry guys. I can't jump on this bandwagon. If I had no more trust in my oncologist than this, I would be a fool to let that person guide the most important medical decisions of my life. Use your own discernment, it is a God given gift, and work with a person you have faith in. I truly can't imagine that anyone savvy enough to be on this board would be in the hands on an oncologist whom they thought might be making decisions as callously as suggested. It is part of the continuing education process to explain the awful true facts about how chemotherapy drugs are delivered and covered by insurance; the docs need to know this to run their practice, to pay their staff, to know how to file-let's don't be to naive here. 99% of these docs would rather not have to worry about how things are handled by insurance, but thank God oxaliplatin in working, is covered, and provides these good people with a way to pay their staff and themselves for all the heartache they carry around for all of us. Could that be what was being explained?

glimmerofhope · May 2006

It sounds like your oncologist has already paid for her vacation home! That is a good thing! As they say in the movie Wallstreet, "That's the thing about money...it makes you do things you don't want to do"

Also, ironically, it sounds like the greedy oncologist is recommending the right thing for the wrong reason, though..... I'm no doc, but I don't believe it is a good idea to put our already stressed digestive tract through the abuse of Xeloda. Along with the oxaliplatin I took about 18 months ago, it put me in the hospital for a week. For me, I'll just take the 5FU intravenously and Avastin as long as it works. It hasn't been very toxic and it has actually worked pretty well.

I may be wrong, but I believe the drug company made the pill form of 5FU (Xeloda) because 5FU was off patent and they wanted to charge more for it, so they dreamed up Xeloda.

Betsydoglover · May 2006

glimmerofhope said:
It sounds like your oncologist has already paid for her vacation home! That is a good thing! As they say in the movie Wallstreet, "That's the thing about money...it makes you do things you don't want to do"

Also, ironically, it sounds like the greedy oncologist is recommending the right thing for the wrong reason, though..... I'm no doc, but I don't believe it is a good idea to put our already stressed digestive tract through the abuse of Xeloda. Along with the oxaliplatin I took about 18 months ago, it put me in the hospital for a week. For me, I'll just take the 5FU intravenously and Avastin as long as it works. It hasn't been very toxic and it has actually worked pretty well.

I may be wrong, but I believe the drug company made the pill form of 5FU (Xeloda) because 5FU was off patent and they wanted to charge more for it, so they dreamed up Xeloda.

Hi - I get what you are saying, but technically I don't think Xeloda abuses our digestive system. It is primarily absorbed in the stomach (most drugs are absorbed in small intestine) - so it doesn't get very far. It is a so called "pro-drug" (becomes more active after liver metabolism) and undergoes triple metabolism in both the liver and at the tumor site - where it finally turns into 5FU. I don't actually think it especially stresses the digestive system more than any other drug you might take. Sorry you had a bad reaction and isn't it a great thing that are multiple drug choices?! Also, while oxaliplatin is probably my life saver, we'll never know - three drugs were given, afterall - but oxaliplatin may well have been the source of your difficulty as it is known for bad side effects. Xeloda is a powerful drug with potentially powerful side effects and if you could not tolerate it, then I am so glad you are no longer on it. And glad 5FU and Avastin are working for you.

We cannot be too cynical about drug companies. But 5FU was first used 40 years ago. So if Roche's motivation for Xeloda development was solely profit, they would have developed it long ago (since patent rights expired long ago).

All this junk said, I am so happy for everyone who is doing well and so hoping for good news from everyone who is still fighting! (And of course I know we are ALL still fighting!)

Take care,
Betsy

2bhealed · May 2006

I think we are being naive if we truly think that in the big picture drug companies have "our best interest" at heart. Hello? They are profit driven not guardian angels. Sorry. Doctors are courted, wined and dined by the drug companies. If you work in a hospital or clinic you see this blatantly.

Now, one on one, are our oncologists caring compassionate people--we hope so. Mine is. But I surely don't fool myself into thinking that the drug companies are saddened and carrying around a heartfelt burden that I was dx'ed with cancer. Man, they're laughing all the way to the bank.

But I got the last laugh....I didn't take the poison.

I have proof that there are clinics that truly don't have our best interest at heart.

I have told you this story before and will tell it again and again and again:

When I consulted a regional chemo clinic who had an oncologist practicing part time at my local hospital I was appalled to see that they were serving DONUTS to their chemo patients. EXCUSE ME??

I asked the oncologist why they were serving cancer feeding sugar foods (not to mention the hydrogenated oils-ugh) to chemo patients!!??

CANCER FEEDS ON SUGAR!!

And he rolled his eyes at me (I kid you not--thank you doctor for your contempt body language) and said that they needed to keep their calories up during chemo.

Well, gee, couldn't they serve bran muffins at least?? but donuts?

He was the deciding factor for me when I otped to not do the chemo. How could I possibly trust this man with my life when he was clueless about cancer nutrition not to mention the patronizing tone.....

I was never planning on doing the chemo--but he proved my point. Very clearly.

Whoever is not profit driven will not have a business for very long. Drug companies are hardly an exception.

I spend my life "out of the woodwork" and on my soapbox!! haha

peace, emily who follows the money!

Betsydoglover · May 2006

2bhealed said:
I think we are being naive if we truly think that in the big picture drug companies have "our best interest" at heart. Hello? They are profit driven not guardian angels. Sorry. Doctors are courted, wined and dined by the drug companies. If you work in a hospital or clinic you see this blatantly.

Now, one on one, are our oncologists caring compassionate people--we hope so. Mine is. But I surely don't fool myself into thinking that the drug companies are saddened and carrying around a heartfelt burden that I was dx'ed with cancer. Man, they're laughing all the way to the bank.

But I got the last laugh....I didn't take the poison.

I have proof that there are clinics that truly don't have our best interest at heart.

I have told you this story before and will tell it again and again and again:

When I consulted a regional chemo clinic who had an oncologist practicing part time at my local hospital I was appalled to see that they were serving DONUTS to their chemo patients. EXCUSE ME??

I asked the oncologist why they were serving cancer feeding sugar foods (not to mention the hydrogenated oils-ugh) to chemo patients!!??

CANCER FEEDS ON SUGAR!!

And he rolled his eyes at me (I kid you not--thank you doctor for your contempt body language) and said that they needed to keep their calories up during chemo.

Well, gee, couldn't they serve bran muffins at least?? but donuts?

He was the deciding factor for me when I otped to not do the chemo. How could I possibly trust this man with my life when he was clueless about cancer nutrition not to mention the patronizing tone.....

I was never planning on doing the chemo--but he proved my point. Very clearly.

Whoever is not profit driven will not have a business for very long. Drug companies are hardly an exception.

I spend my life "out of the woodwork" and on my soapbox!! haha

peace, emily who follows the money!

Hi Emily -

I'm no fan of drug companies. Of course they have a profit motive. And I have to say that I would reject any oncologist who served donuts at chemo sessions. (Even bran muffins are with most recipes usually mostly junk!) But my doc doesn't do that. And while I share many of your opinions, I also believe that when known metastatic disease is present (Stage IV), refusing chemo is probably the kiss of death. Bad as Stage III is, there is no clear evidence of any distant spread. With Stage IV there is clear evidence of distant spread (assuming an accurate diagnosis)and chemo probably has to be a part of the treatment regimen if there is any hope of anything like a "cure".

We live with this "sword" over our heads every day. I sincerely hope I never have to take a chemo drug again. But being Stage IV, I will if I have to. Meanwhile, I continue eating organic veggies etc. and trying to do the best I can to continue a good outcome.

Take care,
Betsy

Interesting Conversation w/ Oncologist

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