Words Fail I think I need to get a punching bag for my office. Or maybe I'll take up kickboxing. I know this much, I'm going to have to do something to vent the perpetual aggression I'm beginning to develop from reading too many articles about mainstream medicine. Today's topic goes beyond infuriating. When I asked my Microsoft Word to help me out with some synonyms for infuriating, it suggested maddening, annoying, irritating, exasperating, and galling. Sorry, Word - that doesn't even begin to cover it. A few weeks ago I told you about a situation that had gone from bad to worse. Here's an update: It's now officially moved on to "worst." First the bad: In the e-Alert "Get Up and Go" (3/27/07), I examined a stunning revelation from the FDA that there is no evidence that Procrit (and other erythropoiesis-stimulating drugs which are used to treat anemia) reduces fatigue, increases energy, or improves quality of life for cancer patients undergoing chemotherapy or radiation. And worse: The FDA also warns that misuse or overuse of these drugs may produce dire results, such as accelerated tumor growth in head and neck cancer, risk of blood clots in patients with kidney failure, and shortened time to death when given to patients not on chemo. And now for the absolute worst: The companies that make these drugs actually pay generous sums to doctors who administer the intravenous medications in their clinics. Not only is this completely legal, but it also encourages the use of higher doses, and higher doses increase the risk of heart attack and stroke. You might wonder if you read that right: Drug companies can actually pay doctors to use their drugs? Amazing (and infuriating!) but true. So how do they get away with it? Easy: rebates. According to a New York Times report, it's all about who buys the drugs. If a doctor prescribes a drug for a patient to purchase, federal law prohibits a drug company from paying the doctor a little kickback for each prescription. But if a doctor runs a cancer clinic or a dialysis center where patients are administered drugs intravenously, then the doctors are the ones who purchase the drugs. In that case, the law allows a drug company to offer rebates on the cost of the drugs. But wait - it gets worse. No only do doctors receive rebates, but the Times notes they also receive reimbursement from private insurers or Medicare. And these reimbursements are often marked up over the price doctor's pay for the drugs. In addition, the more drugs purchased, the higher the rebates, and rebates climb higher still when a doctor agrees to use just one company's drugs. If your ability to feel infuriated, exasperated, and annoyed has just about reached its safe upper limit, please read no further because once again we're about to go from worse to worst. As you might suspect, the rebate program has given sales of this class of drugs a hearty boost. The Times reports that dialysis patients in the U.S. tend to get doses that are more than twice as high as the average for dialysis patients in Europe. And U.S. cancer patients are about three times more likely to be given these drugs compared to European cancer patients. Of course, not all oncologists and dialysis centers are riding on this gravy train, but those who do are making a tidy profit. The Times notes that one U.S. practice consisting of six doctors prescribed $9 million worth of the anemia drugs last year. Their rebate: $2.7 million. Excuse me. I have to go out and buy a punching bag. | 
