John L. Marshall, MD; Bruce D. Cheson, MD; David Kerr, CBE, MD, DSc, FRCP, FMedSci


June 10, 2013

In This Article

Resolved: Stop Burning Money

Dr. Cheson: But we are just focusing on the drugs here. There is a whole world of wasting money in medicine. One of my favorite topics is PET scans. There was a presentation[8] here yesterday which suggested that if you do surveillance scans on patients with Hodgkin's lymphoma, it costs $593,000 to pick up 1 relapse, which you can probably salvage anyhow. Yet people out there are doing scan after scan. If we weren't wasting that money, we could spend more on the drugs that are actually making a difference.

Then there is the other observation that has been made, that 80% of healthcare is for the last couple of months of life. Now, come on; I don't want to throw granny under the train, but there has to be some decision-making because we don't have an infinite number of dollars to spend on medical care.

Dr. Marshall: We had a similar study in colorectal cancer where we obsessively follow patients after a diagnosis because we cure some of those people with surgery. We wanted to find that potentially resectable metastasis. A study just came out that said you can do this with a single snapshot done about a year after your diagnosis. That would be enough, more than 5 years of intensive follow-up.[9] So, money is saved.

I like to think of it as our healthcare closets are full right now. If we are going to bring innovation in, we have to clean some of the stuff out to make room.

Dr. Kerr: I couldn't agree more. We know that drugs costs, although readily identifiable and the subject of huge scrutiny, are 12%-15% of the total healthcare package. If we need to create the room for innovation and for drugs that work, we have to stop doing stuff that doesn't add value. It's your idea of programmatic budgeting to say, "This is the space that you have for cancer. There is no more money. Make decisions. If you want to use the 'ibs' or the this or the that, then you've got to clean out the closet of stuff we do that adds no value."

Dr. Marshall: Who makes those decisions?

Dr. Kerr: Shouldn't it be us?


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