Oncologists to Medicare: We know better ! (Forget that 5 authors received funding)

Oct/23/2007 04:20 Filed in: Pharma Business
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Well it looks like a little battle is brewing in the world of Oncology. Two groups of cancer docs cast the latest stone yesterday in the fight over how to treat anemia in patients getting chemotherapy. The American Society of Clinical Oncology and the American Society of Hematology published revised guidelines (online here) advocating more liberal use of anti-anemia drugs than stricter Medicare rules allow. Is this what is really best for patients or are oncologists looking out for number one ?




Citing safety concerns, Medicare tightened its rules this summer on when it will pay for the expensive anemia drugs (J&J’s Procrit and Amgen’s Aranesp). ASCO and ASH have protested the change, arguing that many patients benefit from more liberal use of the drugs. A key point of debate between the feds and the docs is is when the drugs should be discontinued. Medicare says the drugs should stop when a patient’s hemoglobin rises above 10 grams per deciliter. ASH/ASCO guidelines say patients can be kept on the drugs to keep their hemoglobin between 10 g/dl and 12 g/dL.


A table listing changes from the groups’ older guidelines, published in 2002, shows that while ASH and ASCO have added new warnings about the risk of blood clots associated with the drugs, the groups have gotten a bit more liberal on at least one measure. The earlier guidelines said initiation of treatment with the drugs was recommended when hemoglobin was less than or equal to 10 g/dL. The new guidelines call for initiation when hemoglobin “is approaching, or has fallen below, 10g/dL.” (Both sets of guidelines from the cancer doctors allow physicians to use their discretion in patients with hemoglobin levels between 10 and 12 g/dL.)


Now what is really interesting about this challenge is that eight of the guidelines’ authors said they had no conflicts of interest, but five authors said they had received funding from Amgen and/or J&J. Think there is just a slight conflict of interest here? I am amazed that the industry continues to find clandestine ways to hide behind "thought leaders". Maybe Congress is right and pharmaceutical companies need to disclose all payments to doctors so we can see who is truly in whose pocket.
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