Our guest blogger is Nikhil Wagle, MD, Fellow in Oncology at the Dana Farber Cancer Institute and a board member of Doctors for America.
On Tuesday, Sen. Tom Coburn (R-OK) took his ‘medical expertise’ to the Senate floor to argue that the Senate health care bill would expand government rationing of care. Coburn repeatedly referred to CMS “rationing” of the medication Epogen (aka erythropoetin) – a drug designed to help the body speed up production of red blood cells in cancer patients receiving chemotherapy — to argue that any further government involvement in health care would lead doctors to ignore the needs of their patients:
What this bill’s going to do is divide your doctor away from you… Do we want physicians to be patient-centered and focused on their patients? Or do we want physicians to have their eye on the government and half of an eye on the patient?….I can’t tell you the number of people that died from the Medicare CMS regulations on Epogen for oncologists. But there were hundreds, hundreds, because Medicare never looked at a patient. They looked at dollars. So as we go forward in this debate, what I want seniors in America to know…I want them to know that the key thing they’re going to lose in this bill is they’re going to lose the loyalty and primacy of their physician thinking about them.
It is incredibly irresponsible of Senator Coburn, a physician, to make outlandish claims that patients are dying because they are being denied Epogen (which is intended to improve quality of life by decreasing blood transfusions, not prolong life). He is simply wrong on the facts, and using his position of supposed expertise to scare people into thinking that regulations and guidelines are rationing care when they in fact are protecting patients and doctors.
Coburn specifically refers to an example about using Epogen treatment for a breast cancer patient. What he neglects to point out is that the use of high levels of Epogen in patients with breast cancer can cause serious problems. The BEST trial showed that using high levels of Epogen in patients with breast cancer can actually increase tumor growth and the likelihood of death. Moreover, because metastatic breast cancer particularly increases the risk of blood clots, physicians need to be especially cautious about using high levels of Epogen in these patients (since Epogen can also increase the risk for blood clots).
CMS issued its regulation after consulting with the Food and Drug Administration (FDA), several prominent oncology societies (such as American Society of Clinical Oncology (ASCO) and American Association for Cancer Research (AACR)), as well as Congress. The CMS recommendations on erythropoetin were designed using numerous clinical studies regarding the clinical effectiveness and safety of administering the medication to patients with cancer. Epogen can actually harm breast cancer patients, and guidelines from CMS, the FDA, and professional societies like ASCO are designed to prevent that harm from occurring. Indeed Coburn himself has stated the need for guidelines to be created by professional societies – and here we have the perfect example recommendations being made through a collaborative process with professional societies.
Doctors don’t (and shouldn’t) just decide when something should be done without grounding it in the context of good evidence. We must as least start with do no harm – and Epogen has been proven to harm cancer patient in certain circumstances. And then we must do what works – and Epogen just doesn’t make sense for certain circumstances. That is why the professional societies, FDA, CMS and others sound like a chorus of echoes with their overlapping guidelines and recommendations.