There are some days I just want to quit. From today’s NYT:
In 2006, the National Cancer Institute took the rare step of issuing a “clinical announcement,” a special alert it holds in reserve for advances so important that they should change medical practice.
In this case, the subject was ovarian cancer. A major study had just proved that pumping chemotherapy directly into the abdomen, along with the usual intravenous method, could add 16 months or more to women’s lives. Cancer experts agreed that medical practice should change — immediately.
Nearly a decade later, doctors report that fewer than half of ovarian cancer patients at American hospitals are receiving the abdominal treatment.
So we have a treatment that is proven to work (unlike say, Vitamin D for so many things), but we’re underusing it. Why? The article highlights a number of reasons. It’s harder to give drugs into the abdomen than it is to give them intravenously. Some doctors still don’t believe the results. And, yes, it takes longer and uses generic drugs, so oncologists would make less money doing it. Also, there’s this:
Dr. Markman said that when a treatment involves a new drug or a new device, manufacturers eagerly offer doctors advice and instructions on its use. But this treatment involves no new drugs or devices, so no one is clamoring to educate doctors about it. They are on their own to learn, and to train their nurses, a commitment that will take time and money
We live in a world where financial incentives work and are employed liberally. But for so many things that matter, there are simply no ways to incentivize the right behavior. The system just isn’t build that way. No commercials will ever be run for this therapy. No company reps will ever push it. There will be no fancy meetings about it. No paid monographs. No lobbying by industry groups. And it costs docs financially to do it.
At some point, we will have to start addressing things like this. We can talk about “pay for performance” all we like, but we know the administrative data we measure aren’t looking for things like this. I can scream from this blog all day, but until we can stop fighting the old battles over health insurance and start to discuss how to reform the actual delivery of health care, I fear things aren’t going to get much better.
