What Do You Value Most in a Physician?

It’s a seemingly easy, but extraordinarily difficult question to answer! Yet, what could possibly be more important than finding the right physician to help guide you through your journey with cancer!  Though there may be no definitive answer, there are criteria that you may find highly useful in assembling your care team. Here’s where Lori and I would start the process:    

·         Participation in your insurance plan. Because of the extraordinary cost of health care services, the first screen that most people use when considering a physician is whether they participate in the patient’s insurance plan. Unfortunately, some physicians may be inaccessible to you by virtue of being out of network—meaning that your insurance company has not contracted with these doctors to be part of their physician panel. Unless you are willing to pay heavily out of pocket, which can be financial devastating, you will need to find an in-network provider.

·         Reputation for clinical excellence. Though it is difficult to quantify, every physician knows that there is tremendous variation in quality among doctors. Let’s call it medicine’s dirty little secret. There are ways to improve your probability of finding a clinically excellent doctor: 1) Begin by searching out physicians who enjoy a strong reputation within the community among both consumers and health care professionals—there is probably a good reason for them to be viewed positively; 2) consider a physician who practices at a nationally recognized cancer center.

·         Training and credentials. Lori and I feel this issue bears repeating because the depth and breadth of a physician’s training can also provide a proxy for quality. A basic starting point is to ensure your physician is Board-certified. You may then want to consider a physician who has received sub-specialized training in the form of a Fellowship (it should be noted that there are no fellowships in certain sub-specialties). Some patients also consider where their physicians trained—believing that a Fellowship from a prestigious cancer institute provides yet another level of assurance. As you go through this discernment process, please realize that there are also superlative physicians who do not possess these credentials.

·         Experience. Nothing trumps the value of experience—and the insight, proficiency, and wisdom that can be gleaned through years of practice. Reams of data exist showing the correlation, for instance, between the number of surgical procedures performed by a physician, and his or her outcomes. As Malcolm Gladwell discusses in his book, Outliers, it generally takes a great deal of time to achieve mastery in any endeavor: “In fact, researchers have settled on what they believe is the magic number for true expertise: ten thousand hours.”[i]

·         Alignment with a specific hospital or health system. Your physician is but one cog in the medical “machine” that provides care to cancer patients. The comprehensiveness, quality, and cutting-edge nature of this care will vary dramatically between freestanding centers, hospitals, and health systems. What may be available at your local community hospital could be a mere subset of the offerings at an academic medical center. Depending upon your type of cancer, where you are treated could have a significant impact on your outcome. Remember, if your PCP is an employee of a hospital or health system, he or she is probably strongly encouraged to refer you to specialists within this system. That may or may not be in your best interests.

·         Referral Network. It is important that, when selecting your first specialist, you have some sense of the other physicians to whom you may be referred. If your initial referral is to a surgeon, he or she will likely have a preferred medical and radiation oncologist. Together, they will form your cancer treatment team. Ideally, you would want to conduct some level of due diligence on all of these doctors—but recognizing that timeliness of treatment may be important, that is probably not feasible. Therefore, there is even more reason for you to be comfortable with the system into which you are referred. It is essential that you be confident that all of the physicians meet a minimum standard of excellence.

·         Regular Participation in a Tumor Board. Many cancer specialists attend regularly scheduled meetings in which a panel of diverse specialists review patients’ findings and recommended treatment plans. It allows a specialist, and their patient to receive a multi-disciplinary review of their care and make any recommended course corrections. Lori and I feel strongly about the importance of tumor boards. We would consider making participation a pre-requisite when selecting a specialist. Keep in mind, however, that the treatment of many early stage cancers is so straightforward as to not warrant multi-disciplinary review. Ask your specialist if he or she plans to present your case. If so, request a follow-up report on the consensus of the tumor board regarding your treatment.

·         Gender. Whether you seek care from a male or female physician is primarily a matter of comfort for some patients. This issue most frequently comes into play in cases of breast cancer and genito-urinary tract diseases such as cervical cancer.

·         Interpersonal style. The communication style and emotional intelligence of their physicians matters greatly to some patients and far less to others. Some patients simply want a physician with unquestionable clinical skills and are willing to defer to their physician’s judgment. Others want to actively participate in treatment decisions and need a physician who is an extremely effective communicator, demonstrates clear empathy, and welcomes you as partner on this journey. For patients facing a difficult prognosis, the emotional intelligence and emotional availability of their physician can make a pronounced difference.


This post is an excerpt from After You Hear It's Cancer: A Guide to Navigating the Difficult Journey Ahead (Rowman & Littlefield, July 2015). 

For readers interested in exploring these topics in more detail,  please also consider reading my earlier book: The Myths of Modern Medicine: The Alarming Truth about American Health Care (Rowman & Littlefield, September 2014). Chapter 5 focuses exclusively on physician-related issues and elaborates on a number of the aforementioned topics.



[i] Malcolm Gladwell, Outliers (New York: Little, Brown & Company, 2008).

The "Middle Stage" of Cancer


The following excerpt is from: After You Hear It's Cancer: A Guide to Navigating the Difficult Journey Ahead, John Leifer and Lori Leifer. Rowman & Littlefield (July 2015). 


The Middle-Stage of Cancer:

Many patients enter a midpoint in their journey with cancer. It is what author and ovarian cancer survivor Susan Gubar defines as the “middle stage.” Writing in a June 5, 2014 article in the New York Times, Gubar stated:

For some of us, there is a middle stage in this journey. Because of advances in cancer research and the efforts of dedicated oncologists, a large population today deals with disease kept in abeyance. The cancer has returned and has been controlled, but it will never go away completely. Like me, these people cope with cancer that is treatable for some unforeseeable amount of time. Chronic cancer means you will die from it—unless you are first hit by the proverbial bus—but not now, not necessarily soon.

Allowing for disappointment while not relinquishing hope

When you hit these milestones, it is time to be kind to yourself: a time to express your disappointment without relinquishing your hope. You will be traversing a new path on your journey, but first, you must understand how the additional knowledge acquired to date about your condition impacts your staging, prognosis, and recommended treatment options. Your physician should provide this information, as well as recommended modifications to the treatment plan.

Now’s the time to take out your compass and reassess the direction you are headed. It is essential that you go through an appropriate level of due diligence with your doctor regarding the next phase(s) of treatment. Just as you inquired about efficacy, side effects, treatment duration, and other factors prior to your first course of treatment, you need to repeat the process again now. Three very important questions to consider are:

1. what are the goals of this treatment;

2. what is the likelihood it will be successful; and

3. what short-term and long-term effects may the treatment have on my quality of life? Only once you’ve completed this process can you truly provide your physician with informed consent to proceed.

Expanding the range of clinical resources

Additional physicians may join the team to help you on your journey, depending upon the type of treatment(s) being recommended. Whereas you may initially have been treated only by a surgeon, you may now want to consult with a radiation oncologist, medical oncologist, or other specialists. These physicians may be providing simultaneous interventions. It is essential that they be functioning as a well-coordinated team, since the administration of one therapeutic regimen may affect the timing, dose, or even usage of another treatment modality. For example, patients undergoing chemotherapy may have to carefully sequence their radiation treatments so they do not overwhelm their bodies and increase the probability of adverse effects.

The stakes are higher now because the first line of medical defense has failed. The chances of having a sustained response to treatment diminish, while the level of risks, side effects, and long-term consequences of therapy may be increase.

Due diligence déjà vu

Just as you asked many questions about your initial treatment, so, too, must you feel fully informed about the next steps in your journey. In addition to understanding the fundamental nature of the recommended treatment, you may also wish to ask your physicians the following questions:

  • Why might this treatment be effective when others have failed?
  • Are there other options for treatment that we should discuss?
  • What are the side effects or after-effects of treatment that I may experience?
  • Who will perform this treatment, and what are his or her qualifications for doing so?
  • Will my insurance cover the cost of this treatment?
  • Where I can learn more about this treatment before agreeing to it?

It may be helpful to then take a few days, do your own research, talk with your caregiver, and then come to the most informed decision possible. Regardless of the outcome, you will feel as though you entered this phase of treatment with a solid understanding of its probable outcome, side effects, and costs.


Radio host, David Naimon, (of KBOO FM/Portland) does an excellent job of asking guest, John Leifer, pivotally important questions regarding issues facing recently diagnosed cancer patients and their loved ones. [please note that you may wish to skip past the intro music on the podcast]

Among the many topics covered in this 30 minute interview are:

  • How to evaluate and select a physician
  • How to know whether you are receiving the appropriate treatment for your condition
  • When to obtain a second opinion
  • The importance of understanding the goals of your treatment
  • Differentiating between cure, control, and comfort in cancer treatment
  • Unexplained geographic variations in care, and what they can mean to your treatment
  • Financial issues associated with treatment and how to manage the challenges
  • Identifying if your physician has a financial conflict of interest associated with your treatment...and what this can be mean to your care
  • The role of nutrition and exercise during the journey through cancer
  • The role of complementary medicine in cancer treatment
  • How to obtain more information about your disease and its treatment

The interview came about due to the publication of Leifer's new book, After You Hear It's Cancer: A Guide to Navigating the Difficult Journey Ahead, written collaboratively with his wife, Lori, a radiation oncologist in practice for 25+ years.

John has spent 30 years immersed in the health care industry as a health care executive, consultant, academician, and author. 

In addition to their formal training, John and Lori also bring the perspective of patient and caregiver (Dr. Leifer is a cancer survivor)

Here's a link to the podcast:  https://kboo.fm/afteryouhearitscancerbyjohnleifer  

In the Aftermath of Dr. Farid Fata...A Few Cautionary Words for Cancer Patients

Dr. Farid Fata, a Michigan hematologist oncologist, is simply the latest in a long list of physicians who have betrayed the trust of their patients, bilked the federal government of millions of dollars, and caused unnecessary pain and suffering for thousands upon thousands of patients. On July 10, Fata was sentenced to 45 years in prison based upon nearly two dozen counts of health care fraud, as well as a plethora of other charges.

Rarely are we more vulnerable than when facing a devastating illness like cancer. It’s a time when we often overwhelmed with anxiety, yet have to make decisions that may impact the balance of their lives; it is a time when we would like to believe, without reservation, that our physicians have our best interests at heart. Fortunately, the majority of the time, they do. But what of the exceptions? How do we protect ourselves against the unscrupulous doctors that abuse their cultural authority and the trust bestowed upon them?

There are clear steps you can take to safeguard their health when selecting a medical specialist and undergoing treatment. First, you need to take a very hard, data-driven look at your doctor. There are some basic questions you should be asking, including:

·         Is the physician Board-certified? Though Board-certification is no guarantee of either competency or ethical behavior, it does improve the likelihood of receiving appropriate medical care.

·         How long has the physician been practicing in his or her given specialty area?

·         Have there been complaints filed about the physician with your State Medical Board or can you identify legal action taken against the physician?

·         Does your primary care physician have an opinion regarding the competency of the specialist, and upon what is this opinion based?

Next, you need to understand your purported diagnosis and recommended treatment plan. Your physician should provide and interpret all of the results from your diagnostic imaging studies, laboratory analyses, and other tests.  He or she should then explain, in terms you can understand, the best course of treatment to achieve a specific goal. In cancer care, there are three, potential goals: cure, control, or make one more comfortable.

Before agreeing to the recommended treatment, there are two, critical steps that will help ensure your safety. First, try to determine if the recommended treatment is considered a “standard pathway” or a generally agreed upon method for treating your disease. The National Comprehensive Cancer Network (NCCN.org) publishes guidelines for the treatment of most forms of cancer – including versions that are designed specifically for patients to review. If your physician’s recommendations deviate from these standards, you need to ask why.

Second, don’t hesitate to get a second opinion. If your physician balks or is not supportive of such action, find a new doctor. When seeking a second opinion, search out a specialist who has no affiliation with your current doctor. If there is a National Cancer Institute Center in your city, this may be a good place to start.

Doctors are every bit as mortal as you and I (trust me, I’m married to one…albeit a very good one). Fortunately, most physicians believe that it is a sacred responsibility to provide the best possible care.

We all know the saying about “a few bad apples.” When you find yourself faced with a serious illness, such as cancer, your job is to find the good ones!

Five Essential Steps When First Diagnosed With Cancer

“When you hear the word ‘cancer,’ it’s as if someone took the game of Life and tossed it in the air. All the pieces go flying. The pieces land on a new board. Everything has shifted. You don’t know where to start.”  —Regina Brett[i]

A diagnosis of cancer can be overwhelming, but knowing a few basic things can help make the journey ahead far more manageable. Here are five key things you should know if you or a loved one has recently been diagnosed with cancer:

1.      It is normal to feel completely overwhelmed when you hear the word cancer. Despite the anxiety, and accompanying sense of urgency to begin treatment, you must slow down and be methodical about the next steps.

2.      Identify a caregiver who can be at your side throughout the journey ahead. Your caregiver will fill a number of important roles, including:

·         Serve as a scribe during your doctor appointments so that you have an accurate record of what transpires. This person can also be helpful in keeping other family members or loved ones informed.

·         Request copies of your records from all physicians seen related to your cancer. Be certain that the records include all imaging studies and pathology reports.

·         Help you navigate the complex health care system, while coordinating your care, as needed, across multiple physicians and treatment sites.

·         Provide essential emotional support.

·         Help you address basic functional needs at a time when many of your resources are consumed simply fighting your disease.

3.      Before you can proceed, it is essential that you understand your diagnosis, the goals of treatment, and treatment options based upon objective information presented by knowledgeable physicians.

·         Oftentimes this requires visiting multiple specialists – including surgeons, as well as medical and radiation oncologists. Since there often numerous methods for treating a disease, these specialists may render differing opinions regarding what is best for you.

·         It is important to keep in mind that specialists have an understandable predilection for the types of interventions they deliver – a surgeon may be biased towards surgical procedures just as a radiation oncologist is biased towards radiation therapy.

·         Such differing opinions can be confusing for the patient…particularly since you are now navigating in unfamiliar territory. Before making a decision about treatment, there are three things that you must know:

o   As a general rule, the treatment should be based upon a “standard of care” – meaning that there is a consensus in the medical community regarding the best method(s) for managing your disease. The National Comprehensive Cancer Network, or NCCN, publishes such standards of care, or evidence-based pathways, for many types of cancer. Consumer-friendly versions of such pathways are available for free on their web-site (www.nccn.org). You would be well-advised to review the NCCN recommendations for your disease (and stage of disease). If your doctor is recommending a treatment that appears to deviate from the standards of care, ask him or her why.

o   There are pros and cons for every treatment – both in terms of the relative effectiveness of the treatment, as well as the short-term and long-term potential side-effects. Only by understanding these nuances of treatment can you make a truly informed decision about what is right for you.

o   There may be substantial differences in the costs associated with different interventions. While we all want and deserve the best treatment available, two treatments may be virtually identical in terms of the outcomes produced, but vary dramatically in costs. Before your out-of-pocket expenses grow astronomically, you may wish to discuss the projected cost of care with your doctors. Your physician should also inform you if he or she has a financial conflict of interest whereby they will profit more from the delivery of certain types of treatment. A  urologist, for example who treats prostate cancer with a linear accelerator owned by the group has an ethical obligation to disclose this conflict to the patient.

4.      Now that you are armed with far more information about the best course of treatment for your condition, you need to decide who will deliver your care and where you will receive it. Before you put blind trust in your doctors, you need to know that not all physicians (or facilities) are created equal – in fact, there’s tremendous variance in the relative quality of care delivered by different doctors at different hospitals/clinics. Unfortunately, sorting out the good apples is not the easiest task. Here are three suggestions for improving the odds of having a highly competent medical team:

·         Learn as much as you can about your physicians’ training, and experience treating your particular disease. There’s nothing wrong with interviewing your physicians! You should be sizing up your doctor, not only in terms of clinical training/experience/competency, but also how you feel at a gut-level about having them lead you through this difficult journey.

o   Keep in mind that practice does not make perfect, but when combined with the right training and certain inherent skills, it can make a huge difference. For instance, an oncologic surgeon who, after completing a fellowship in breast cancer surgery, has been practicing for ten years at a premier facility may produce different results than a general surgeon whose most frequent procedure is repairing a hernia. Unfortunately, there is no readily available data that allows us to compare the relative competency of our physicians.

·         Consider the depth and breadth of the cancer treatment resources available at your facility of choice. Do your best to separate out the marketing hyperbole from the cold, hard facts regarding the facility’s capabilities. It’s relatively easy to go to the hospitals’ websites within your community and compare capabilities. If there is an NCI-designated Comprehensive Cancer Center in your community (which differs from an NCI-designated Community Cancer Center), and have not selected it as your provider of choice, you may wish to get a second opinion at this facility. If you have an early stage, easily treated disease, this may be less of a concern than with more advanced or difficult to treat tumors.

·         Be careful about listening to the advice of your backdoor neighbor or cousin Martha about who the best doctor in town is for your cancer. Their intentions will undoubtedly be spot on, but their knowledge may be highly flawed. Author Marty Makary, M.D., a Johns Hopkins physician, talks about Dr. Hodad – a popular physician with a wonderful bedside manner whose patients think he walks on water (HODAD turns out to be an acronym for hands of death and destruction).


5.      Never under-estimate the power of hope in helping get you through the journey. Though no one welcomes cancer into their life, a great many people experience tremendous growth as a result. Hope can be the force that helps you emerge on the other side…stronger, more resilient, and with a unique appreciation for the wonderful life you’ve been given.

There are many more steps to transforming an arduous journey into a manageable one. What I’ve outlined here are five of the most basic. If you would like to read more, I would strongly encourage you to read: After You Hear It’s Cancer: A Guide to Navigating the Difficult Journey Ahead.

The book is available at Amazon.com (http://www.amazon.com/After-You-Hear-Its-Cancer/dp/1442246251/ref=sr_1_3?ie=UTF8&qid=1423064996&sr=8-3&keywords=john+leifer#)  or through the publisher – Rowman & Littlefiel (https://rowman.com/ISBN/9781442246263).



I would welcome your questions or comments. Please post them by clicking on the headline of article.





[i] Regina Brett, BrainyQuote, http://www.brainyquote.com/quotes/quotes/r/reginabret586752.html.

When Cancer Drugs Are Priced Beyond the Reach of Patients

The blog post below was originally entitled, "Profits vs. Patients in the Escalating War on Cancer," and was targeted to health care professionals.  But the issue of costs -- egregiously high costs -- is having such a profound impact on cancer patients that I felt it appropriate to address it here -- where people struggling to navigate the difficult journey through cancer can read and dialogue about vitally important issues.

Something must be done to address the pharmaceutical industry's relentless profiteering on the backs of cancer patients. People must speak up and call for change.  

Please read the article below and then let me hear your thoughts about how we can address this profound issue.  




Beyond the caring rhetoric carefully crafted by providers of cancer treatment and therapeutics, there exists a motivation every bit as powerful as saving lives -- reaping billions of dollars in profit. That's what is at stake in the ongoing war on cancer -- a war in which important battles have been won, but at a tremendous cost.

As the number of cancer patients grows and their treatments become increasingly expensive, we will find ourselves locked in an unwinnable war of attrition…unless reining-in costs becomes as much of a priority as expanding our medical armamentarium.  

 How the battlefield changed:

 Despite the fact that cancer incidence rates have declined for the most frequently occurring types of the disease, cancer continues to impact 40 percent of all Americans, and it is responsible for 20 percent of all deaths. That translates into 1.66 million newly diagnosed patients annually and nearly 600,000 deaths, according to the National Cancer Institute. Incidence tells only part of the story, however. More importantly, the majority of cancer patients are surviving longer.

 There are currently more than 14 million Americans who have survived cancer—a dramatic increase from the 3 million survivors in 1971. While much of this increase is attributable to population growth, improvements in cancer therapies have also played an essential role. As a result, for many patients, cancer has been transformed from a death sentence into a chronic disease that perhaps cannot be cured, but can be controlled for an extended period of time.

 The soaring costs of care:

 Fifty years ago, direct spending on cancer care equaled $1.3 billion. By 1995, spending had soared to $41.2 billion, and by 2010, it was an estimated $125 billion. That’s an almost 10,000 percent increase in direct spending over fifty years. Add in the indirect costs of care, such as lost productivity, and the numbers almost triple.

 Cancer care was not the only part of the nation’s health care bill that rose dramatically over time. In 1950, total health care costs for the U.S. equaled $12.7 billion. By 2012, those costs had risen to $2.6 trillion – a 20,000 percent increase in the span of three generations

 Such costs have taken quite a toll. Today, the single greatest cause of personal bankruptcy in America is medical bills. In fact, “The percentage of personal bankruptcies in the United States attributed to health care costs rose from 46.2% in 2001 to 69.1% in 2007.” Such statistics come as no surprise, since patients are bearing an increasing proportion of the cost burden associated with expensive treatments. Medicare beneficiaries who are often on a limited, fixed income are particularly hard hit.

 What Lies Ahead:

The estimated cost burden for the coming decades is fuzzy at best. The NIH guesstimates that the direct costs of cancer care could range anywhere from $158 billion to $207 billion. A number of factors are contributing not only to cost escalation, but also to the complexity of forecasting. 

 We know that the projected level of growth in the 65+ segment of our population—which is the segment most affected by cancer—will result in a virtual tsunami of cancer patients. What we don’t know is how these patients will be treated, or the costs of emerging therapeutic modalities.

 Furthermore, with the number of cancer survivors forecast to grow to 19 million by 2024, there will presumably be a dramatic increase in the long-term costs of controlling their disease and maintaining their well-being.

 History demonstrates that the cost of cancer does not increase linearly, but rather in a manner reminiscent of Moore’s law—a factor that proves beneficial when describing the growing power of computers, but not the growing costs of care. Nowhere is this more apparent than in the skyrocketing costs of pharmaceutical products.

 A Pharmaceutical Gold Rush

 The pharmaceutical industry has doubled-down on its investment in cancer therapeutics—a wise move, considering the increased market demand reported by industry monitor, IMS:  “The global market for oncology drugs, including those used in supportive care, reached $91 billion in 2013…this compares with $71 billion in 2008 and $37 billion a decade ago.”

 With demand soaring and sales burgeoning, much of pharmaceutical research now centers on beating cancer. IMS concluded that, “cancer therapies account for more than 30 percent of all preclinical and phase I clinical development products…”   

 It’s not just demand that is driving the soaring sales of cancer drug. It’s the manner in which drugs are priced. In the U.S., which accounts for 40 percent of all cancer drug sales, there are no governing rules regarding pricing, beyond what the market will bear. While most consumer products are priced based upon comparative value, the price of cancer therapeutics appears to be plucked from the ether with no relationship to the drug’s relative efficacy or toxicity.

 Don’t take my word for it, look at the numbers: According to an article in the Journal of Clinical Oncology, “Of the 12 anticancer drugs approved by the FDA in 2012, only three prolonged survival, two of them by less than 2 months…yet nine were priced at more than $10,000 per month.” One drug, approved for the treatment of pancreatic cancer, was shown to extend survival by a mere 10 days.

 According to an article published by the Mayo Clinic, “Last year, ipilimumab (Yervoy; Bristol-Myers Squibb, New York, NY) was approved by the Food and Drug Administration (FDA) for the treatment of metastatic melanoma. The benefit in survival over and above standard treatment was 3.7 months in previously treated patients and 2.1 months in previously untreated patients. The cost: $120,000 for 4 doses.”

 It appears that $100,000 per year has been set as the minimum threshold for introducing new cancer therapies.  But it is not just the introductory pricing of drugs that is problematic. It is also the price inflation of cancer drugs that is raising costs astronomically. The price of imatinib, a drug used to treat CML (chronic myeloid leukemia) increased from $30,000 to approximately $90,000 over a ten-year period.

 Lies, Damn Lies, and Statistics:

 The pharmaceutical industry justifies what appears to be morally egregious behavior by explaining that drug costs are primarily driven by research costs. In fact, stating that the cost of bringing a drug to market now exceeds $1 billion has become almost a mantra—but it is patently invalid.

 Pharma’s argument regarding the tremendous costs of research was effectively eviscerated in a November 15, 2013 article in the prestigious journal Cancer.  Authors Donald Light, Ph.D., and Hagop Kantarjian, M.D., demonstrated that the actual cost probably approaches $125 million or one-eighth of what has been claimed.

 You Don’t Have to Sell Drugs to Profit from Cancer:

 It’s not just pharma that is profiting from this gold rush.  Cash-strapped hospitals and health systems are lining up to ensure that cancer provides a rosy bottom line for their institutions.

 Not only are facilities expanding the depth and breadth of cancer services offered, but they are now employing oncologists at an unprecedented rate. Such employment accomplishes multiple objectives: 1) It locks in the physicians who control patient flow in the market, thus locking in market share; 2) it allows the hospitals to increase the costs of the oncologists’ services by billing them as hospital outpatient services; 3) it allows hospitals to capture all the procedural revenue—imaging, radiation, and surgery—associated with these patients; 4) it allows hospitals to increase profits on the resales of cancer drugs using what is known as “340b” pricing.

 Numerous other parties stand to profit handsomely from the growth of cancer—including, but not limited to health information technology companies that seek to capitalize on the tremendous data-demands associated with cancer research, medical technology vendors, and even manufacturers of prosthetics.

 Re-establishing equilibrium between Patients and Profits:

 Until payers realign incentives so that providers are rewarded based upon achieving the most efficient and effective patient outcomes over time, there will be an imbalance between the needs of patients and the pull of profits.

There are specific steps that can be taken today to achieve these objectives, including:

  • Physicians must act as fiduciaries for their patients’ health and well-being. As such, they must demand comparative effectiveness data that show the relative value of a cancer drug. Physicians can drive change simply through their prescribing patterns, and they must wield this power appropriately on behalf of their patients. This principle was proven effective when a group of oncologists at Memorial Sloan Kettering refused to prescribe the drug Zaltrap because it was twice as expensive as an alternative drug yet no more effective. The manufacturer bowed to the pressure and cut the price of Zaltrap by 50 percent.
  • The FDA can aid these efforts to move from “what the market will bear” pricing to value-based pricing by establishing minimal thresholds for comparative efficacy while also factoring in the comparative toxicity of drugs under consideration. .
  • There must be clear and unequivocal prohibitions on any conflicts of interest that allow physicians to profit, beyond their professional fees, for the provision of cancer therapeutics—be it a chemo agent, radiation treatments, or other modalities.
  • The Department of Justice must bring greater scrutiny to the acquisition of major oncology groups or other actions that may result in the creation of monopolies or oligopolies in cancer care.
  • Congress must reconsider the prohibitions on governmental agencies, such as Center for Medicare and Medicaid Services (CMS), from negotiating prices with pharmaceutical manufacturers.
  • As a society, we must struggle with through discussions of what we are willing to expend in order to extend life, while factoring in the patients’ probable quality of life. Discussions of “death panels” must yield to rational, albeit difficult conversations.

 The Time to Act is Now:

 Health care providers and vendors have proven that they are incapable of being self-regulating. They have also proven that they are subject to the same moral vices as the rest of society, including greed. There needs to be immediate action to stop the profiteering off the backs of cancer patients, while war of attrition, simultaneously using our health care dollars wisely in the quest to conquer cancer.

To add a comment, please click on the title of this post. 

Taking Your Foot off of the Accelerator

There is one piece of advice that Lori and I offer without equivocation to newly diagnosed cancer patients – slow down…take your foot off of the accelerator, and realize that you’ve begun a journey not a sprint.  Though certain diagnoses mandate prompt action, it should never be at the expense of level-headed thinking that leads to a clear understanding of your options.

The Role of a Caregiver

Your first order of business is to identify a caregiver, often times a family member, who will accompany you on your journey. There will be moments when you are unable to process important information about your diagnosis and treatment.  That is when your caregiver becomes your scribe – taking notes, recording comments, doing whatever is necessary to retain critical data to help you make informed decisions.

The Right Care Team

The second order of business is to ensure that you are enlisting the right health care resources to give you the optimal chance of a positive outcome.  Your cancer care team will likely include a multi-disciplinary array of providers. Physicians, like all human beings, vary significantly in their knowledge, competency, experience, and interpersonal style. Since you are entrusting your health to these individuals, you should get to know them, and feel comfortable with them.

As part of this process, you need to also consider the health system with which your doctors are affiliated. Health systems, too, vary dramatically in their capabilities. If you have a complicated diagnosis or a difficult condition to treat, some systems may be better suited to meet your needs, such as National Cancer Institute (NCI) affiliated centers or more sophisticated community cancer centers.

Understanding Standards of Care

Next, it is imperative that you understand your diagnosis. For virtually every diagnosis, there is a standard of care – pathways that define the optimal methods for treating a disease at different stages of development.  As a consumer, there are tools that describe many of these care pathways. You can find them online at www.ncccn.org/patients/. 

You will quickly discover that there are often multiple options or pathways for treating your disease. Different treatments may be equally effective in controlling or eliminating your cancer, but vary in other important ways. Take the treatment of Stage 1 breast cancer for instance. A lumpectomy followed by radiation has the same statistical likelihood of curing your cancer as a mastectomy, but is far less invasive, requires little to no reconstructive surgery, costs less, and involves a far shorter recover. Yet, for some very legitimate reasons, many women still opt for the mastectomy. There’s not a right or wrong decision…as long as the patient is truly informed as to the options and trade-offs.  

Seeking a Second Opinion

Once your care team has provided you with a diagnosis, including the location, stage, and grade of your cancer, as well as treatment recommendations, it’s time to consider a second opinion. A second opinion may be less critical for early stage cancers that are easily treated than for complicated diagnoses. A second opinion should provide peace of mind that a proper diagnosis has been rendered and appropriate treatment options explored.

When seeking a second opinion, we advise people to consider consulting with a new team of physicians at a different health system. Once again, an NCI-designated center may be a great option if available in your area. Prior to arranging the second opinion, be certain that you have all of your medical records, including diagnostic imaging and other tests, readily available for the consulting physicians.

Discernment and Prayer

Once you have the requisite information about your condition and recommended treatment in-hand, it is time to think carefully about everything that you have heard. Use your caregiver, family, and friends as a sounding board as you work through the best options for you.  Once you have discerned the answer, you can put your foot gently back on the accelerator, and pray for a safe journey ahead.


All of these topics are covered in far greater detail in After You Hear It’s Cancer: A Guide to Navigating the Difficult Journey Ahead.


The Beginning of Our Journey Through Cancer


 While many people revel in Christmas, my wife loves the sanctity of Easter. So it was no surprise Lori wanted to attend sunrise Easter services on March 31, 2013. The service was jubilant, and we spent the day feeling that all was right with the world.

 When I finally crawled into bed around 11:00 p.m., I began to drift, though I wanted to stay awake until Lori finished her shower. A few minutes later, Lori quietly drew back the covers and slid into bed. I woke long enough to tell her I loved her and give her a short kiss. Then I was out—until her sobs summoned me back to consciousness.

 “What’s wrong? What’s going on? What did I do?” I asked.

 There was no response for what felt like an eternity. Then, in an uncharacteristically weak voice, Lori said, “I found something in the shower.”

 “What do you mean you found something in the shower?” I said anxiously.

 “I found a lump. It is two centimeters. It’s cancer.”

 Not only had Lori found a lump in her breast, but also, as an oncologist, she had determined its size and that it was malignant. I knew she was a great doctor, but I prayed there was room for error. Many times during our marriage, I hoped Lori was wrong but never more than at this moment.

 My wife, a radiation oncologist, would soon go from being a provider of care to a receiver of it. Lori and I would gain a new perspective about why the word cancer, rolling slowly and menacingly from our physicians’ mouths, rattles us to the bone. It is a word we hope never to hear—certainly not in the context of our health or the health of a loved one.

 When you hear the word cancer, it’s as if someone took the game of Life and tossed it in the air. All the pieces go flying. The pieces land on a new board. Everything has shifted. You don’t know where to start.

—Regina Brett


As one patient said, “I thought I was going to die. I thought I was going to pass out. I was upset. I called my roommate and I was hysterical. I didn’t know what to do. I was like blown away. It was a complete shock. To me, ovarian cancer is a death sentence.”

 Yet cancer is part of the human condition. It strikes approximately one-third of women and one half of men at some point in their lives. In 2014, an estimated 1.66 million people received a diagnosis of cancer. They joined a pool of 13.7 million Americans already living with cancer, the vast majority of whom are fifty-five or older.

 Overall, newly diagnosed cancer patients will have a 68 percent chance of surviving for five years or more—a dramatic gain from forty years ago, when the survival rate was less than 50 percent. Even so, nearly 600,000 Americans will die from cancer this year, making cancer the second-leading cause of death in our country.

 If you’re lucky, the journey will be a short divergence from life’s path. For some, however, it will be a dramatic fork in the road to an unknown future. For all, it is a life-changing diagnosis.


 Imagine going on a trip without knowing the destination or method of transportation, with no map to guide you and no planned arrival time. Now imagine you are leaving tomorrow, and there is no time to pack.

 It is little wonder that cancer patients often feel overwhelmed, shut down, and are unable to participate in crucial decisions about their care. Our logical minds stop working just when we need to be thinking with absolute clarity about our next steps.

 Karen Sepucha, a professor at Harvard Medical School and one of the leading authorities on how patients make crucial health care decisions, explained it to me this way:

 By the time people face cancer, they’ve usually faced other major issues in their life and made other difficult decisions. What I have found is that, sometimes, when they get into the medical community, they forget all of that. So people who have pretty advanced ways of taking care of their families and making good decisions all of sudden get to the doctor’s office and lose all of the skills that allow them to question things, get other opinions—things that they would do in any other aspect of their life.

It is a moment when time stands still, a moment laden with anxiety and uncertainty. A new journey is beginning, and it is one for which we are ill prepared. 


To read more, please order a copy of After You Hear It's Cancer: A Guide to Navigating the Difficult Journey Ahead. 

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