Top Cancer Center Claims a Consultancy First. Critic Disagrees

Nick Mulcahy

August 05, 2021

Resource-rich American hospitals and cancer centers have long catered to international patients who can afford the care, both in person and via telemedicine.

But it's not easy, says one expert.

"There are significant hurdles that foreign patients face when seeking care in the United States, including language barriers, cultural differences, different time zones, collecting and translating medical records, and much more," said Mrinal Gounder, MD, a medical oncologist and "physician ambassador to India and Asia" at Memorial Sloan Kettering Cancer Center (MSKCC) in New York City.

In a move that aims to expand the number of paying patients with cancer in India who can overcome those hurdles and access American expertise, the renowned New York City institution has launched MSKCC India.

The entity will be headquartered in the city of Chennai, home of MSK's partner in the venture, iCliniq, an Indian telemedicine company.

The new partnership will provide "culturally competent and timely care to Indian patients suffering with cancer" and features "highly trained medical and logistical staff to help coordinate all care," either online or in person, Gounder told Medscape Medical News.

All of those elements add up to what MSKCC calls a "first of its kind" consultancy in a press statement.

But a critic of the initiative says it's a money grab — and in that regard, is not novel at all.

"Based on my experience, these 'partnerships' are purely for-profit, intended to capture the market share from rich patients who are willing to pay big amounts for getting treatment at these brands," said Bishal Gyawali, MD, PhD, a medical oncologist at Queen's University in Kingston, Ontario, Canada, who was asked for comment. Other big US medical centers do the same thing in various "emerging economies," he said.

This is not altruistic "global oncology work," Gyawali told Medscape Medical News, adding that it "may be marketed as such."

MSKCC India's specific consulting services, which will mostly be second opinions, include pathology diagnosis, radiology scan reviews, next-generation sequencing of a patient's tumor, and treatment recommendations.

"Memorial Sloan Kettering physicians will serve as resources to treating oncologists in India," Gounder explained.

He also spoke of lofty goals for MSKCC India that include education and training collaborations with oncologists, patient advocates, and scientists. "This sort of comprehensive effort is critical to providing the level of care that patients need in India and beyond, and to ultimately eradicate cancer in the 21st century globally," he said.

However, at this time, any beneficiaries are restricted to those who can self-pay.

Hundreds of Indian Physicians in the Network

Money drives these collaborations, not a sense of service, says Gyawali, who is well known for research and advocacy work in low- and middle-income countries. Now based in Canada, he has previously worked in Belgium and the United Kingdom, went to medical school in Japan, and was born and raised in Nepal.

MSKCC India "will not cater to the needs of the poor people that constitute the majority of the cancer population," he added.

The well-traveled medical oncologist saved his most important criticism for last — that entities such as MSKCC India "promote overtreatment all around."

"MSKCC India will probably offer many of the low-value treatments that are common in the USA" but are prescribed much less elsewhere because of marginal benefits and high costs, he said.

This can lead to copy-cat wastefulness among local physicians, Gyawali explained.

"They don't want to be seen as 'less knowledgeable' for not prescribing ramucirumab in colorectal cancer, for instance," he said about local doctors, suggesting that they would start using such "low-value" drugs to keep up with trendsetters like MSKCC India.

MSKCC's Gounder observed that it has many ties in India: "Over the last several decades, hundreds of physicians from India have trained at Memorial Sloan Kettering Cancer Center in New York and other institutions in the United States and have now become part of our network in India."

These network doctors are offered periodic educational programs, he noted, and mentioned a recent virtual event held July 29, entitled, "MSKCC-India Interchange on Dealing with Cancer During COVID-19."

MSKCC India will rely on this network to make its consultancy a success, he said. "The only motivation to refer patients is to help them obtain the best possible outcomes as they struggle with a challenging disease."

Nick Mulcahy is an award-winning senior journalist for Medscape, focusing on oncology, and can be reached at nmulcahy@medscape.net and on Twitter: @MulcahyNick

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