How Much Longer Will We Put Up With $100,000 Cancer Drugs?

  • Of 91 new therapies approved for solid tumours between 2002 and 2016, the median overall survival benefit was little more than two months. 
  • Yet the annual price tag per patient now regularly exceeds $100,000.

 European School of Oncology

Paul Workman, Giulio Draetta, Jan Scellens and Rene Bernards wrote an article, How Much Longer Will We Put Up With $100,000 Cancer Drugs? DOI: http://dx.doi.org/10.1016/j.cell.2017.01.034

  • The spiraling cost of new drugs mandates a fundamentally different approach to keep lifesaving therapies affordable for cancer patients.
  • As early as 2012, 12 of the 13 newly-approved cancer drugs were priced above $100,000 annually, and the situation has only gotten worse since (Light and Kantarjian, 2013, Mailankody and Prasad, 2015). For instance, the cost of the combination of nivolumab (anti-PD-1) and ipilimumab (anti-CTLA4) is priced around $252,000, exceeding the median cost of a US home ($240,000 in 2016).
  • With a lifetime risk of developing cancer of close to 40%, the problem is clear.
  • The pharmaceutical industry has traditionally defended these high prices by pointing at the high attrition rate during clinical drug development and the cost of large registration studies.
  • If development cost would be a major factor in the pricing structure, a simple law of economics would have mandated a considerable reduction in price when the eligible patient population increases, but that has hardly happened.
  • This is a recurring theme in pharma. For instance, trastuzumab was first approved for advanced breast cancer and later also for early disease (adjuvant) without a reduction in price. Healthcare payers should not accept this lack of price-volume relationship.
  • Moreover, there is very little relationship between drug price and clinical benefit (Mailankody and Prasad, 2015). This has sparked widespread criticism, alleging that cancer drug pricing is primarily based on “what the market will bear.” 
  • There is a clear and urgent necessity to lower cancer drug prices to keep lifesaving drugs available and affordable for patients. As one patient advocate recently put it: “Innovation is meaningless if nobody can afford it.”
  • Much has been written about the reasons behind the exorbitant drug prices and what to do about it. One recurring theme is the notion that the US federal government is prohibited by law from negotiating drug prices as a result of the 2003 Medicare Prescription Drug, Improvement and Modernization Act.
  • Considering that Medicare and Medicaid spend $ 140 billion on medicines annually, this represents a serious impediment in driving down drug prices. Lack of competition and a general absence of a connection between drug price, sales volume, and clinical performance are other arguments in the drug pricing discussion (Jaffe, 2015).
  • Indeed, lack of competition and bargaining power made US prices of cancer drugs among the highest in the world, increasing by 10% annually between 1995 and 2013, far above the average inflation rate (Howard et al., 2015).
  • While negotiations may bring prices down, a recent cost comparison in EU countries shows that the ability of individual nations to negotiate discounts is limited, most likely due to the modest market sizes of the EU countries (van Harten et al., 2016).

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Beware the Medical-Industrial Complex

Stevens CW1Glatstein E.   Oncologist. 1996;1(4):IV-V.

  • “. we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military industrial complex.” Dwight D. Eisenhower, 34th President of the United States (1953-1961). Farewell Address, January 17, 1961.
  • If Ike were with us today, he might well expand his views on power and influence to include modern American medicine. The corporatization of health care in the United States has moved rapidly in recent years.
  • New developments in cancer treatment include expensive technological “bells and whistles” which physicians must ultimately evaluate objectively, despite lush advertisements from companies with obvious vested interests, and authoritative testimonials from biased investigators who presumably believe in their own work to the point of straining credulity and denying common sense.
  • The 3-D image that was created by a computer may look beautiful (and cost accordingly), but it is hard to believe that it can fundamentally change the outcome of patients when it does not add any new data that bear on basic issues.
  • Thus, new equipment will be exploiting issues of convenience, efficiency, and increased throughput (translate: economic improvement, not biological superiority).
  • We must remember that every new therapy costs money ….
  • Improvement in cancer cure rates has been frustratingly slow. We work against a clever, tenacious adversary – both in the clinic and in the corporate board room. It is our responsibility to tout our accomplishments, admit our failures, and provide progressively better basic and clinical research with an eye toward future improvements in outcome. We must not be seen as yet another special interest come to drink at the well of public spending, but as advocates for the public good.

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The prince and the pauper. A tale of anticancer targeted agents.

Dueñas-González A1García-López PHerrera LAMedina-Franco JLGonzález-Fierro ACandelaria M.   Mol Cancer. 2008 Oct 23;7:82. doi: 10.1186/1476-4598-7-82.

  • Cancer rates are set to increase at an alarming rate, from 10 million new cases globally in 2000 to 15 million in 2020.
  • Regarding the pharmacological treatment of cancer, we currently are in the interphase of two treatment eras. The so-called pregenomic therapy which names the traditional cancer drugs, mainly cytotoxic drug types, and post-genomic era-type drugs referring to rationally-based designed.
  • Although there are successful examples of this newer drug discovery approach, most target-specific agents only provide small gains in symptom control and/or survival, whereas others have consistently failed in the clinical testing.

There is however, a characteristic shared by these agents: their high cost.

============================================== 

Anticancer Drug Development: The Way Forward.

Connors T1. Oncologist. 1996;1(3):180-181.

  • Cancer chemotherapy celebrated its fiftieth anniversary last year. It was in 1945 that wartime research on the nitrogen mustards, which uncovered their potential use in the treatment of leukaemias and other cancers, was first made public.
  • Fifty years later, more than sixty drugs have been registered in the USA for the treatment of cancer, but there are still lessons to be learnt.
  • One problem, paradoxically, is that many anticancer agents produce a response in several different classes of the disease. This means that once a new agent has been shown to be effective in one cancer, much effort is devoted to further investigations of the same drug in various combinations for different disorders.
  • While this approach has led to advances in the treatment of many childhood cancers and some rare diseases, a plethora of studies on metastatic colon cancer, for example, has yielded little benefit. 5-fluorouracil continues to be used in trials, yet there is no evidence for an increase in survival.
  • The lesson to be learnt is that many common cancers are not adequately treated by present-day chemotherapy, and most trials of this sort are a  waste of time.
  • Significant increases in survival will only occur if the selectivity of present-day anticancer agents can be increased or new classes of more selective agents can be discovered.

 

 

Part 3: You should not continue with your medical treatments if you have run out of funds.

capture8

SF had already spent around RM 150,000 for her treatment. She said her financial reserve was running low. My advice: You should not continue with your medical treatments if you have run out of funds. It does not make sense to give up half way through the treatment due to lack of funds. Think carefully.

 

 

C: We are here not just to sell our herbs. We want to help people. We want to open their minds to new possibilities. We want them to think for themselves and not led by the nose — jumping into a bottomless pit and at the same time leaving a big hole in your bank account.

So let me ask you this — what do you hope to get from rounds and rounds of treatment. I guess you want a cure, right? Unfortunately, from what I read and know, there is no cure for cancer. So first, understand that there is no cure for your cancer. Second, these treatments are going to bring you more sufferings. Third, you will have to spend a lot more money.

So Ibu (mama) even if you undergo another round of treatments, I don’t see how you are going to be able to solve your problem. After the radiation and chemo, you needed an operation if the tumour shrinks. If the tumour does not shrink, you will go for more and more chemo. So your journey does not end yet. It may just be the beginning of another long journey. Please think carefully.

Many Indonesians who came to see me underwent medical treatments without asking any question or much thinking. After undergoing the treatment half-way, they said: I have no more money. So I don’t want to continue with the treatment.  My response was: Why are you so dumb. If you don’t have enough money to go through the entire course of treatment, why did you ever start with the treatment in the first place?

There was this 35-year-old lady from Palembang. She had breast cancer and underwent a mastectomy. After the operation, she was asked to undergo chemotherapy, radiotherapy, and be on oral medication. The total cost of these treatments came to about RM200,000. I asked her: Do you have money to pay for this treatment? Her reply, No.

Yes, I understand a 35-year-old cannot be expected to have RM200,000 in her bank account. So even if she wanted to undergo the recommended treatment, she could not. So, I said to her, It’s okay. No need to do the treatments. There is no point undergoing the treatment half-way and then stop!

Did you understand what I am trying to tell you?

P: I understand.

C:. This is one important point I want you to consider now. In the next 2 days you need to go for chemo. You were told you needed 3 cycles initially. Okay, how much will that cost? Then calculate the cost of your stay in Malaysia. After that you need to go for an operation. What is the cost of that surgery?

Husband: RM 25,000 for the surgery alone.

C: Okay, RM 25,000 plus 3 x RM4,000 for the chemo and previously RM6,700 for the radiation. After the surgery you may need more chemo, and more chemo. Consider all these costs. I don’t know about your financial status. So you need to make a decision after careful consideration.

Is the chemo and surgery going to cure you or bring your more sufferings?

P:  I don’t want any more chemo or surgery. I only want you to help me. The doctor said he would remove my right kidney together with the ureter (tube that carries the urine from the kidney to the bladder).

C: What is going to happen to you after that? They will fix a tube. And one kidney gone.  Do you really want to undergo such treatment?

P: At first I didn’t want.

C: What is the purpose of removing these? Think first! One important question to ask. Will the doctor be able to remove all the cancer inside you? And after the operation it is all clean and the cancer would not come back again? Can surgery do that? What happen if after the surgery the cancer becomes more aggressive and spreads more widely.

Learn from nature — for example the ant’s nest. What happen if you take a parang and cut the nest into two? What if you leave the nest undisturbed?

P: All the ants will spread out.

C: I am not an expert in cancer but I use my head to think. And I also want you to think properly. Now, after you have just received 3 sessions of radiation, you had diarrhea. That bothered you a lot. You have not even started with your third rounds of chemo yet. You have already had 12 cycles of chemo and I don’t know what can happen to you if you have more chemo. You may end up dead?  Again, if the tumour does not shrink this time around, you will need more and more chemo. When will that end?

Do you understand what I am trying to tell you?

P: Before this, I don’t understand. I just accept what I was told to do. I don’t know that there is another way out.

C: No, there is NO way out of this.

P: I know. Everything is in God’s hand.

By all means, sell your house or land to pay for the medical bills if the treatment is going to cure you!

C: There is this young man who came to see me. His mother had lung cancer and had gone to China with a few of her friends for treatment. After the first trip to China, the mother ran out of money. She wanted to sell her house in which 5 of her children were living in. The son came to seek my advice. My answer: If you sell the house and your mother is cured, that’s okay. Worth the gamble. But what happen after all the treatments — money gone, and she is not cured? House gone, mother dead? And the children left out in the street without a home to go to.

My advice was not to go to China for the treatment anymore. She survived 3 years after following our therapy. She had a normal life and was able to help her son in his motor-bike repair shop. Her friends who had money and continued with their treatments in China were ALL dead.

I have no magic potion for your cancer

C: I want you to think carefully. If I just want to sell you my herbs, I would have asked you to buy all that you need and go away. Why talk so much and so long? But the mission of CA Care is to help others. That is why I want you to go home and think carefully first. There is no need to take the herbs now. Why? Because in two days time you want to start with your chemo. Go and do your chemo first.

Our herbs are no magic potion. Healing cancer takes more than just drinking herbs. Cancer is about human being — the need to change your attitude, life style and diet. I am not asking you not to go for chemo. I just want you to give a careful thought to what I have said.

Husband: You have opened our minds. I begin to understand what is happening now.

P: I did not understand all these before.

 

 

Blood test: Different lab different result

breach-sabah

BS is a 47-year-old male who was diagnosed with colon cancer in December 2014. He underwent a surgery in hospital A in Penang. It was a Stage 2A cancer. No chemo, radiation or medication was recommended.

About a year later,  21 January 2016, BS underwent another procedure to remove 2 polyps in his colon. A CT scan was also done and the results were not good:

  1. There were multiple nodules in both lungs. The largest one measures 1.2 cm. This is not see in the previous scan.
  2. There was a small cyst in segment 3 of his liver, measuring 1.1 x 1.1 cm.

The above findings are consistent with metastases. BS was asked to undergo chemotherapy and also take the oral drug, Xeloda. He refused and decided to take our herbs and take care of his diet. Later, BS also told us that he went to Bali to learn how to meditate (baliusada.com), which I believe did him a lot of good.

To monitor his progress, BS did a full blood test on 14 July 2016 in a private laboratory. The results was good.

Alpha-fetoprotein = 2.1, CEA = 2.7, CA 19.9 = 29.6 and CA 125 = 6.2.

Three months later, 18 October 2016, BS did another full blood test in a private hospital. The results was not good.

Alpha-fetoprotein = 1.38, CEA = 9.1, CA 19.9 = 17.96

His CEA has increased from 2.7 three months ago to 9.1. BS felt upset and disappointed. We discussed what had happened. For the past month, BS had been under extreme stress. His young nephew was robbed and murdered. Apart from that, he slacked on his diet. My advice to BS. Don’t worry so much for now. Try and relax and let’s see what happen in the next three months. We shall repeat the blood test.

But to be sure, I suggested that BS repeat this CEA test with a private lab which we always send our patients to and which he went to earlier. So BS repeated the same CEA test the next day, 19 October 2016.

Lo and behold, CEA from the private lab returned a normal value of 2.5, which is more than 3 times lower than the results obtained by the private hospital. I then suggested that BS repeat this same test in his hometown. The result was CEA = 8.4. So here it goes, three different labs came up with three different numbers!

Now, what has gone wrong? And which result is the correct measure of the situation? What could have been the consequences of such mistake? No doubt about it, BS could have been told to undergo chemotherapy since the cancer has recurred. Or BS would have to do a PET scan to find out what had gone wrong. But, is it true that something had gone wrong?

I have learned not to trust blood test results since years ago. This is because my patients make me see the reality of what happened in the real medical world. One prostate cancer patient went to three labs one morning and made them evaluate his PSA level. The results from the three tests were all different! Here goes the reliability of scientific medicine.

Then, Jennifer regularly monitored her CA 125. The value was around 400 plus which was high. One day, she went to a well known private hospital in Kuala Lumpur and did her blood test. The result was shocking, her CA 125 shot up to 800 plus. Panic, she called me. This was what I told her. I think the result from that private hospital was wrong! Someone must have made a mistake!. To know the truth, repeat the test. Jennifer went to a university hospital. Her CA 125 was back to 400 plus — similar to the previous level.

What can we learn from these episodes? Patients pay for the mistakes that other people in the hospital make! So patients, BEWARE. Just imagine, in panic Jennifer could has been sent for chemotherapy immediately because of the mistake made by someone in the lab.

How serious and how often things like this happen is for anyone to guess! Indeed sad. Ponder the quotations below and always be on guard!

9-error-in-tests

10-path-reports-not-correct-al

 

 

 

Why do cancer drugs get such an easy ride?

BMJ 2015350 doi: http://dx.doi.org/10.1136/bmj.h2068 (Published 23 April 2015)Cite this as: BMJ 2015;350:h2068

Donald W Light, professor and Joel Lexchin, professor 

Rushed approvals result in a poor deal for both patients and cancer research

Unlike most other diseases, cancer instils a special fear and “is treated as an evil, invincible predator, not just a disease.”

The ability of drug companies to charge very high prices, even when most approved cancer drugs provide little gain for patients, drives much of the research, as desperate patients lead some governments and private insurers to pay whatever companies charge.

Officials within the US Food and Drug Administration are enthusiastic about new cancer drugs. Richard Pazdur, who oversees oncology activities for the FDA says that new cancer drugs are so effective that “We don’t have a lot of questions on [these] drugs because they’re slam dunks. It’s not if we’re going to approve them. It’s how fast we’re going to approve them.”

The methodological weaknesses in oncology trials do not support such enthusiasm.

Trials for cancer drugs were 2.8 times more likely not to be randomised, 2.6 times more likely not to use a comparator (single arm), ….

and to READ MORE ….. Article access for 1 day: Purchase this article for £23 $37 €30 * http://www.bmj.com/content/350/bmj.h2068

If you don’t have the money to pay for a one day access to this article, try “googling” the subject matter, and with some luck you get a “free ride” and enjoy comments from various sources.

From http://www.sciencedaily.com/releases/2015/05/150507135917.htm: Highly priced cancer drugs get rushed approvals despite poor trial methodology and little effect on the longevity of patients, cautions York University Professor Dr. Joel Lexchin in the School of Health Policy and Management.

“Patients and their doctors should demand that regulators require pharma companies to provide clear evidence of clinical effectiveness of the drugs, resulting from rigorous methodology,” suggests Lexchin. “Drug agencies like the Food and Drug Administration (FDA) and the European Medicine Agency (EMA) don’t actually look at whether people live longer.”

In an article in the British Medical Journal, titled “Why do cancer drugs get such an easy ride?,” Lexchiin and co-author Donald Light, a professor in the School of Osteopathic Medicine, Rowan University in New Jersey, note that accelerated approval and shortened review times also make it a smooth sail for cancer drugs.

Lexchin cites earlier research reviewing solid cancer drugs within 10 years of EMA approval to point out that these drugs improved survival by just over a month.

“Similarly 71 drugs approved by the FDA from 2002 to 2014 for solid tumours have resulted in median gains in progression-free and overall survival of only 2.5 and 2.1 months, respectively,” he says adding, “Also, only 42 per cent met the American Society of Clinical Oncology Cancer Research Committee’s criteria for meaningful results for patients.”

From: http://www.yourhealthbase.com/ihn260.pdf: How Effective Are Newer Chemotherapy Drugs?

  • An editorial in the April 23, 2015 British Medical Journal examined the recent accelerated drug approval process for cancer drugs in both the US and Europe. The subtitle was “Rushed approvals result in a poor deal for both patients and cancer research.”
  • This editorial contains some extremely disturbing statistics and information the authors obtained from reviewing the chemotherapy clinical study literature and other papers over the last 8 to 10 years.
  • Between 2007 and 2010, … almost 9000 oncology clinical drug trials were compared with trials for other diseases, the former were 2.6 times more likely not to use a comparator and 1.8 time more likely not be blinded (open to bias from the investigators) … this undermine the validity of the outcomes, it also reflect what regulators will allow. (In lay man language this means bad research. And the regulators — FDA, allows that!).
  • The European Medicine Agency … found that new oncology drugs improved survival by a mean of 1.5 months and a median of 1.2 months.
  • The 71 drugs approved by the US FDA from 2002 to 2014 for solid tumors have resulted in median gains in progression-free survival of 2.5 months and overall survival of 2.1 months. (Pay thousands of ringgit plus suffer side effects and you live 2.5 months longer? Not cured? As you told about this before you started paying though your nose?).
  • Post-marketing changes in the package insert (so-called label) were substantially greater for oncology drugs given priority approval as compared to those going through the much longer standard process, which the authors suggest reflects deficiencies in the accelerated review process. (In layman language it means, quicky, sloppy job — a rush to make quick bucks?)
  • Both the European and US regulators allow companies to test cancer drugs using a surrogate endpoint rather than survival or other more patient-centered outcomes. Tumor size is given as an example of an unreliable endpoint since it is highly variable in predicting overall survival. (In layman language the measure of trial outcome is not reliable. Just making the size of tumor smaller — or tumour shrinkage — may not mean anything. Surely it does not mean the cancer is cured! So, the measure of effectiveness is faulty).
  • In 2013, two peer-reviewed papers appeared where a total of over 100 oncologists protested against the high prices being charged for cancer drugs when 11 out of 12 approved in 2012 provided only small benefits for patients. (Do you realize that chemo drugs are getting more expensive …the prices of the newer drugs are beyond our imagination. But are they effective? Yes, make you live longer by 2 or 3 months????? But patients want a CURE)
  • The authors term the approval process an “Easy Ride” and suggest that this serves both patients and research badly.
  • It can also be argued that the majority of cancer drug development research currently leading to new drug approval is bogged down in merely getting more ineffective drugs approved in the hope that marginal improvements in survival will lead to enhanced profits. (The root of this evil is greed! They go after your cancer or after your money?)
  • … generally priced so high that the choice is between bankruptcy or declining treatment except for the wealthy.
  • The results discussed above are consistent with those presented in 2004 by Morgan et al14. Based on reports from Australia between 1992 and 1997, the contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was 2.3% whereas in the US it was 2.1%. These results suggest that over this period in these two countries chemotherapy made little contribution to cancer survival. (Yes, they tell you … chemo will give 60% chance, 99% chance, bla, bla …the Australian showed chemo is only 2 or 3% effective).
  • Furthermore, not much appears to haves changed between 1992 and 2014 from the patient’s perspective. It is important to note that we are talking about cancers that involve solid tumors. (Why change or improve? As it is – the drug companies are happy, hospitals and doctors are happy! And patients believe and trust them!)
  • BOTTOM LINE: When offered one of the new “wonder” chemotherapeutic drugs, it is important to ascertain the actual expected life extension in order to weigh this against the side effects. Trivial life extensions are sufficient to gain regulatory approval and allow patients to be told the treatment will extend their life. Unless carefully qualified, such an approach appears unethical.

 

 

RM 2,830 lost for not wanting to proceed with radiotherapy

TT was diagnosed with cervical cancer. She underwent an operation to remove her uterus, ovaries and omentum. She was then referred to an oncologist who recommended both chemotherapy and radiotherapy. TT was not at peace at all about undergoing these invasive treatments but she did not have any other choice. She consulted with the oncologist three times and was assured that everything would be okay and that chemo and radiation were her only option — nothing else. During her second meeting with her oncologist, TT was told to pay RM 13,000 as a deposit for her radiation treatment.

Someone told TT about CA Care. TT and her husband decided to forgo further medical treatments. TT went back to hospital and cancelled her appointment for her radiotherapy. What then happened to the RM 13,000 deposit?  Can TT get a refund? Listen to this video.

 

Gist of what TT and her husband said.

  1. They were angry. Why don’t you want to go for radiotherapy? We are still unprepared!
  2. For your RM 13,000 deposit, we could only refund you RM 4,500. The remaining amount is forfeited.
  3. Why must I lose that much money for just not wanting to go for radiotherapy? We have not started with any treatment yet?
  4. Husband started to take pictures of the person. When I go back to Indonesia, I shall report this to the mass media
  5. Okay, okay be patient. Let me consult.
  6. You have to pay for the oncologist’s fee — RM1,700 and the cancer hospital fee is RM 6,000 plus.
  7. The treatment has not even started yet. Why so expensive? It was only the nurse who made some markings. We did not even see the doctor yet.
  8. TT and her husband was referred to the finance department. They demanded to know: Why must I lose so much money just to cancel the treatment? Your hospital comes to Indonesia for publicity. What I can do is to go home and tell the press about this. Okay, you can have your RM 8000 plus, return me my RM 4,500. It is okay. I am not a poor man. I can come to Penang for treatment means I can afford it.
  9. The hospital called up the cancer hospital and after some discussion said: Hang on for 10 minutes. We have miscalculated.
  10. The actual figure: RM 2,830 to be forfeited to cover the following cost:

HospitalBill Tiu Tjin Tjhin

Question: Do you mean that by just asking a patient to go for radiotherapy the oncologist earned RM1,700 up front?  Even when no treatment was given?

When you saw the oncologist three times for consultation, did you pay him any fee? Yes, of course, we paid him RM 60 for each visit. So, this RM1,700 is over and above his consultation fee.

The hospital earned RM 1,130 for putting marks on my tummy!

Comment

We have nothing much to say about this episode. Just feeling sad. Reflect on the quotations below and perhaps we all can learn something about the present-day “so-called-noble-profession.”

Medicine a business

As I was writing this story, there is this news report … if there is anything we can learn from this story it this: Before you proceed with any treatment, ask these important questions first:

  1. Can the treatment cure me or not?
  2. What are the risks and side effects?
  3. What will that cost me in total — financially and emotionally?

Don’t get caught up with the idea of wanting to only win. Know that you can lose the “battle” badly as well. In this case below: Imagine, daughter had an operation, (did the parents ask — can cure or not? can win?), then she was paralyzed, hospital bills came to more than RM 2 million !!!, parents declared bankrupt (besides the frustration and heartaches). That is not wining at all. So patients, beware.

Penang Adventist Hospital ordered to pay couple RM6 million

FMT Reporters:  July 15, 2015

See more at: http://www.freemalaysiatoday.com/category/nation/2015/07/15/penang-hospital-ordered-to-pay-couple-rm6-million/#sthash.HiQCSfF3.dpuf

The couple were earlier declared bankrupt after they could not pay the hospital RM2.35 million in unsettled medical bills.

GEORGE TOWN: The Penang High Court has ordered the Penang Adventist Hospital (PAH), a private centre, to pay RM6,023,802 in damages to the parents of a 18-year-old paralyzed girl.

The victim’s parents, Kee Boon Suan and his wife Ang Mooi Sim from Nibong Tebal, filed the suit three years ago. The High Court had ordered the couple in 2011 to settle RM2,350,013.85 due to the hospital in unpaid bills. The court order led the couple to be declared bankrupt.

In his verdict on the medical negligence suit here on Tuesday, Judicial Commissioner Nordin Hassan said he found PAH and three doctors had committed medical negligence during a spinal surgery performed on Kee Jun Hui on June 4, 2008.

He said the patient’s parents were also not briefed by the doctors-in-charge on the surgery details.

He said the hospital was responsible for the negligence acts by the doctors-in-charge and nurses, who had breached their duties and duty of care to the patient.

Nordin said PAH orthopedic surgeons Dr. Cheok Chee Yew and Dr. Wong Chung Chek neglected their duties after performing the surgery on Jun Hui.

He said the patient had collapsed several times during the post-surgery recovery period while still under the hospital’s custody.

He said anesthetist Dr. Patrick K. S. Tan neglected his duties and failed to instruct hospital nurses to attend to the collapsed patient after being informed of Jun Hui’s inability to move her limbs.

M.S. Dhillon, Rhina Bhar and K.B. Karthi represented the plaintiffs while Mahindra Singh Gill acted for the hospital.

All three doctors were represented by legal counsel J. A. Yeoh.

Mahindra later told newsmen that PAH would appeal against Nordin’s judgment at the Court of Appeal.

In 2011, PAH originally hauled Kee and Ang to court for failure to settle their medical bill for Jun Hui’s surgery.

In 2012, the couple sued the hospital for medical negligence, as their daughter was paralyzed after the surgery.

The hospital was named the first defendant in the suit followed by Cheok, Patrick Tan and Wong.

 

 

 

 

The cost of cancer drugs

Lesley Stahl discovers the shock and anxiety of a cancer diagnosis can be followed by a second jolt: the astronomical price of cancer drugs

  • And as anyone who’s been through it knows, the shock and anxiety of the diagnosis is followed by a second jolt: the high price of cancer drugs.
  • They are so astronomical that a growing number of patients can’t afford …..

Dr. Leonard Saltz: We’re in a situation where a cancer diagnosis is one of the leading causes of personal bankruptcy… We’re starting to see the term “financial toxicity” being used in the literature. Individual patients are going into bankruptcy trying to deal with these prices.

“I do worry that people’s fear and anxiety’s are being taken advantage of.”

Lesley Stahl: The general price for a new drug is what?

Dr. Leonard Saltz: They’re priced at well over $100,000 a year …  And if you figure one drug costs $120,000 and the next drug’s not going to cost less, you’re at a quarter-million dollars in drug costs just to get started.

Dr. Saltz’s battle against the cost of cancer drugs started in 2012 when the FDA approved Zaltrap for treating advanced colon cancer. Saltz compared the clinical trial results of Zaltrap to those of another drug already on the market, Avastin. He says both target the same patient population, work essentially in the same way. And, when given as part of chemotherapy, deliver the identical result: extending median survival by 1.4 months, or 42 days.

Dr. Leonard Saltz: They looked to be about the same. To me, it looked like a Coke and Pepsi sort of thing.

Then Saltz, as head of the hospital’s pharmacy committee, discovered how much it would cost: roughly $11,000 per month, more than twice that of Avastin.

Another reason drug prices are so expensive is that according to an independent study, the single biggest source of income for private practice oncologists is the commission they make from cancer drugs. They’re the ones who buy them wholesale from the pharmaceutical companies, and sell them retail to their patients.

Dr. Hagop Kantarjian: High cancer drug prices are harming patients because either you come up with the money, or you die.

“They are making prices unreasonable, unsustainable and, in my opinion, immoral.”

When we asked Novartis why they tripled the price of Gleevec, they told us,… When setting the prices of our medicines we consider … the benefits they bring to patients … The price of existing treatments and the investments needed to continue to innovate…”

The challenge, Dr. Saltz at Sloan Kettering says, is knowing where to draw the line between how long a drug extends life and how much it costs.

Lesley Stahl: Where is that line?

Dr. Leonard Saltz: I don’t know where that line is, but we as a society have been unwilling to discuss this topic and, as a result, the only people that are setting the line are the people that are selling the drugs.

Read more: http://www.cbsnews.com/news/the-cost-of-cancer-drugs/

 

Articles from the Internet: How Safe Or Unsafe Are Medical Imaging Procedures?

Yeong Sek Yee & Khadijah Shaari 

To understand more about the radiation risks from medical imaging, we recommend that you read the following articles posted in the Internet.  Just Google topics like the dangers of medical/diagnostic tests, etc, etc. There are plenty of materials to read. Here are some examples.

1.       Medical Radiation Soars, With Risks Often Overlooked

Radiation, like alcohol, is a double-edged sword. Radiation can reveal hidden problems, from broken bones and lung lesions to heart defects and tumors. But it also has a potentially serious medical downside: the ability to damage DNA and, 10 to 20 years later, to cause cancer. CT scans alone, which deliver 100 to 500 times the radiation associated with an ordinary X-ray and now provide three-fourths of Americans’ radiation exposure, are believed to account for 1.5 percent of all cancers that occur in the United States.

Although the cancer-causing effects of radiation are cumulative, no one keeps track of how much radiation patients have already been exposed to when a new imaging exam is ordered. Even when patients are asked about earlier exams, the goal is nearly always to compare new findings with old ones, not to estimate the risks of additional radiation.

Read more:  http://well.blogs.nytimes.com/2012/08/20/medical-radiation-soars-with-risks-often-overlooked/?utm_source=twitterfeed&utm_medium=twitter

2.       Radiation Risks from Medical Imaging

The FDA has put forward its plan to reduce unnecessary radiation exposure from CT scans, nuclear medicine studies, and fluoroscopy.

An individual’s chance of getting cancer from a single scan is small. But because the scans are so widely used, they cause a considerable amount of harm. One study estimated that the CT scans performed in 2007 are related to some 29,000 future cancers.

What are these tests? What are their risks? When do the tests’ benefits outweigh their risks? Here are WebMD’s answers to these and other questions.

How much radiation does a person get from medical imaging studies?

  • Getting a CT scan gives a patient as much radiation as 100 to 800 chest X-rays.
  • Getting a nuclear medicine study exposes a patient to as much radiation as 10 to 2,050 chest X-rays.
  • Getting a fluoroscopic procedure exposes a patient to as much radiation as 250 to 3,500 chest X-rays.

Moreover, doctors may prescribe scans that aren’t medically justified. And since risk from radiation exposure accumulates over a lifetime, certain scans may not be appropriate for people who’ve already had a lot of scans.

Read more: http://www.medicinenet.com/script/main/art.asp?articlekey=114953

3.       Dangers of Medical Imaging Tests and Procedures

Exposure to medical imaging radiation is a concern in both adults and children. However, radiation exposure in children is of a greater concern because they are more sensitive to radiation than adults. In addition, children have longer life expectancy than adults. With repeated exposure or accumulated exposure to radiation, children may be more likely to develop health problems in the future.

Life time risk of developing cancer increases when a patient undergoes more frequent X-ray exams and at larger doses, according to the FDA. Women who are exposed to the radiation may have higher lifetime risk for developing radiation-associated cancer than men after receiving the same exposures at the same ages.

While experts believe that the risk of developing cancer with radiation exposure is relatively small, radiation exposure through these medical imaging tests should never be taken lightly.

Read more:  http://voices.yahoo.com/dangers-medical-imaging-tests-procedures-5452681.html?cat=5

4.       A Closer Look: The Downside of Diagnostic Imaging

CT and nuclear medicine tests do have a downside, however: they deliver doses of ionizing radiation from 50 to over 500 times that of a standard x-ray, such as a chest x-ray or mammogram. Scientists have raised concerns that such large doses of radiation plus the widespread and increasing use these diagnostic procedures may, in a small but significant way, pose a cancer risk in the general population.

“The use of CT in particular has gone up dramatically, and we’ve drastically lowered the threshold for using it,” said Dr. Rebecca Smith-Bindman, a visiting research scientist with NCI’s Radiation Epidemiology Branch (REB). “There’s a general belief that if you get a CT scan, you must be reasonably sick and must really need it. This is no longer true, and we are increasingly using CT scans in patients who are not that sick. There’s been drift not only in how often we use it but in how we use it.”

“We’ve only talked about the benefits of CT for the past 20 years, without considering any potential harm” she continued.

Research estimated that approximately 29,000 future cancers could be related to CT scans performed in the United States in that year alone, with women being at higher risk than men. About 35 percent of these cancers were projected to be related to scans performed in patients 35 to 54 years old, and 15 percent related to scans performed in children younger than 18. 

The medical community has proposed many ways to reduce radiation exposure from diagnostic medicine without negatively impacting the quality of patient care:

  • Reduce the number of CT exams by using other technologies (such as ultrasound or MRI) in cases where they would provide equal diagnostic quality.
  • Limit the use of CT in healthy patients who would obtain little benefit (such as whole-body CT screening).
  • Limit the use of repeat CT surveillance of patients in whom a diagnosis has already been made, when repeat scanning would lead to little change in their treatment.
  • Track and collect information on radiation exposure for individual patients

Read more: http://www.cancer.gov/aboutnci/ncicancerbulletin/archive/2010/012610/page8

5.       Ionizing Radiation Exposure with Medical Imaging

Medical diagnostic procedures used to define and diagnose medical conditions are currently the greatest manmade source of ionizing radiation exposure to the general population. The risks and benefits of radiation exposure due to medical imaging and other sources must be clearly defined for clinicians and their patients.

Radiation damages the cell by damaging DNA molecules directly through ionizing effects on DNA molecules or indirectly through free radical formation. A lower dose delivered through a long period of time theoretically allows the body the opportunity to repair itself. Radiation damage may not cause any outward signs of injury in the short term; effects may appear much later in life.

Medical ionizing radiation has great benefits and should not be feared, especially in urgent situations. Obviously, using the lowest possible dose is desired. In fact, a central principle in radiation protection is “as low as reasonably achievable.” Therefore, the prescribing physician must justify the examination and determine relevant clinical information before referring the patient to a radiologist. Indications and decisions should reflect the possibility of using non-ionizing radiation examinations, such as MRI or ultrasonography.

Repetition of examinations should be avoided at other clinics or sites.

The International Commission on Radiological Protection (ICRP) estimates that the average person has an approximately 4-5% increased relative risk of fatal cancer after a whole-body dose of 1 Sv.

X-rays (including CT scans) should be ordered judiciously. An article in the New England Journal of Medicine notes that the evidence is “convincing” that the radiation dose from CT scans can lead to cancer induction in adults and “very convincing” in the case of children. Clinicians need to realize that doses from a typical CT scan can range from 6-35 times higher than the dose of a standard chest x-ray examination.

Read more:  http://emedicine.medscape.com/article/1464228-overview#a30

6.  Doctors Order More Tests when They Benefit Financially: Ask If You Really Need that Test Your Doctor Ordered

Researchers from the Institute for Technology Assessment at the Massachusetts General Hospital Department of Radiology found that there was no mistaking that diagnostic imaging tests were being ordered far more than they deemed necessary. The question that begs to be answered is, “why?”

Many doctors referred their patients to imaging centers that were affiliated with their practice, or were even done by the doctor’s own staff. When a physician has such a close relationship with the provider conducting the imaging study, there is the possibility that the physician will benefit financially from ordering additional imaging studies.

Read more: http://voices.yahoo.com/doctors-order-more-tests-they-benefit-financially-631960.html?cat=5

7.       Radiation Danger from CT and PET Scans

A recent study in the New England Journal of Medicine has found a significant link between radiation exposure and imaging procedures such as CT and PET scans. The use of such technologies has grown from just 3 million in 1980 to 67 million in 2006, and has contributed, some estimate, to upwards of 2% of fatal cancer cases.

Studies have shown that there is little consumer understanding of the risks involved in being subject to such procedures.

Dr. Harlan M. Krumholz proffers that the use of CT scans is increasing because they have become part of our culture. “People use imaging instead of examining a patient; they use imaging instead of talking to the patient,” (New York Times, Study Finds Radiation Risk for Patients, August 27, 2009). For these reasons, imaging technologies have become a common diagnostic tool even when they are not required.

Read more: http://blog.hcfama.org/2009/08/27/radiation-danger-from-ct-and-pet-scans/

8.       Study Finds Radiation Risk for Patients

At least four million Americans under age 65 are exposed to high doses of radiation each year from medical imaging tests, according toa new study in The New England Journal of Medicine. About 400,000 of those patients receive very high doses, more than the maximum annual exposure allowed for nuclear power plant employees or anyone else who works with radioactive material.

Dr. Rita Redberg, a cardiologist and researcher at the University of California, San Francisco, who has extensively studied the use of medical imaging, said it would probably result in tens of thousands of additional cancers. It’s certain that there are increased rates of cancer at low levels of radiation, and as you increase the levels of radiation, you increase cancer.

Dr. Reza Fazel, a cardiologist at Emory University, said the use of scans appeared to have increased even from 2005 to 2007, the period covered by the paper. “These procedures have a cost, not just in terms of dollars, but in terms of radiation risk.”

Read more: http://www.nytimes.com/2009/08/27/health/research/27scan.html?_r=0

9.      Radiation Exposure from Medical Diagnostic Imaging Procedures

Ionizing radiation is used daily in hospitals and clinics to perform diagnostic imaging procedures.

Which types of diagnostic imaging procedures use radiation?

•  In x-ray procedures, x rays pass through the body to form pictures on film or on a computer or  television monitor, which are viewed by a radiologist. If you have an x-ray test, it will be performed with a standard x-ray machine or with a more sophisticated x-ray machine called a CT or CAT scan machine.

• In nuclear medicine procedures, a very small amount of radioactive material is inhaled, injected, or swallowed by the patient. If you have a nuclear medicine exam, a special camera will be used to detect energy given off by the radioactive material in your body and form a picture of your organs and their function on a computer monitor. A nuclear medicine physician views these pictures. The radioactive material typically disappears from your body within a few hours or days.

Do magnetic resonance imaging (MRI) and ultrasound use radiation?

MRI and ultrasound procedures do not use ionizing radiation. If you have either of these types of studies, you are not exposed to radiation.

There is no conclusive evidence of radiation causing harm at the levels patients receive from diagnostic xray exams. Although high doses of radiation are linked to an increased risk of cancer, the effects of the low doses of radiation used in diagnostic imaging are not known.

Read more: https://hps.org/documents/meddiagimaging.pdf

10.        Radiation Risk of Medical Imaging for Adults and Children

Which kinds of tests are associated with Ionising radiation and which ones are not?

1.  X-rays
X-rays are ionising radiation produced by equipment used in the following types of procedures:

  • Computed tomography (CT)
  • Fluoroscopy (where the image produced by the X-ray beam is made into a moving picture on a TV screen
  • Plain radiology/X-ray film, digital and computed radiography (see  Plain Radiography / X-rays)
  • Mammography (see Diagnostic Mammography)
    • The radiation exposure from having an X-ray, fluoroscopy, mammography or CT examination only occurs while the machine is on.

2.  Magnetic resonance imaging (MRI)
MRI uses strong magnetic fields and radio waves to produce images. It does not use ionising radiation (see Magnetic Resonance Imaging (MRI)).

3.  Ultrasound
Ultrasound uses high frequency sound waves that the human ear cannot detect to obtain imaging information (see Ultrasound).

4.  Nuclear medicine
Nuclear medicine is a medical specialty that involves the administration of a small amount of a radioactive material into the patient. The patient becomes weakly radioactive for a short time and images are made from the radiation given off from the patient (see Nuclear Medicine).

How do I decide whether the risks are outweighed by the benefits of exposure to X-radiation when I have a radiology test or procedure?

  • Ask your doctor about the procedure and how it will help to provide information about your symptom or the presence of disease or injury.
  • Ask your doctor about the risks of the procedure and what the risks would be of not having the procedure, i.e. if your doctor needs the information in order to identify and plan the most appropriate treatment.

While there is a small risk of harm from ionising radiation, there could be a greater risk of not having the information, e.g. failure to detect potentially serious disease that may be easily treated at an early stage but harder to treat or incurable if detected later.

It may also be as beneficial to you to confirm the absence of disease or injury as it is to confirm its diagnosis.

Read more: http://www.insideradiology.com.au/pages/view.php?T_id=57

11.   Radiation in Medical Imaging Has Its Risks

Almost all medical procedures, including imaging procedures that use radiation, have risks associated with them. Physicians and patients should carefully consider the potential benefits and the risks when considering the use of imaging techniques that involve radiation.

Here are some things for healthcare providers to consider when deciding whether or not an imaging procedure that uses medical radiation is the right choice.

  • What is the purpose of the procedure? For example, is it to arrive at a diagnosis, assess treatment response, or is it preventive screening?
  • Are there alternative imaging procedures that could accomplish the same goal without medical radiation, such as ultrasound or magnetic resonance imaging?
  • What are the risks of not having the imaging procedure done?
  • How old is the patient? The risks for pediatric and adolescent patients may be different than for adults.
  • Is the patient pregnant, possibly pregnant, or breastfeeding?
  • What other procedures is the patient likely to undergo during this workup?
  • What is this person’s radiation exposure from previous medical procedures? For example, has the person undergone multiple CT or nuclear medicine scans in the past?
  • What is this person’s occupational exposure to radiation, if any?
  • Will the imaging exam be performed on low-dose equipment?

The standard unit of measure for radiation absorbed by an individual is called the “Sievert,” or Sv (sometimes identified by a smaller unit called the “millisievert,” or mSv). Common medical imaging tests such as X-rays or mammograms generally expose patients to a radiation dose of less than 1 mSv.

Other procedures using CT, nuclear stress tests, or fluoroscopy-guided exams often involve radiation in the range of 5-40 mSv.

single exposure at these diagnostic levels may not pose much risk to the patient. But when a patient has numerous tests over a period of time, the cumulative exposure may raise the level of risk. To minimize cumulative exposure, physicians should determine whether a procedure using medical radiation is necessary to achieve the diagnosis or whether an alternative imaging procedure may offer the same diagnostic benefit.

Read more:  http://www.gehealthcare.com/dose/medical-radiation/benefits-and-risks.html

12.   How Safe or Unsafe Are Medical Imaging Procedures?

Radiation exposure is a known risk factor for cancer. Recent estimates suggest, for example, that as many as two percent of cancers could be attributed to radiation during CT scans. Although the radiation exposure from a single test is minimal, the frequency of the use of imaging tests that emit radiation continues to grow expansively, and often patients undergo repeated or multiple types of tests, thereby increasing their cumulative exposure to potentially cancer-causing radiation.

Read more:  http://www.sciencedaily.com/releases/2009/08/090826191837.htm

Advice to Patients

Lately, we have noticed that certain medical centres have been urging   cancer patients to perform regular CT or PET scans (some every 3 months)  to “monitor” the progress of their cancer treatment. Sometimes some cancer patients think that such CT/PET scans are “treatment” itself. The medical establishment obviously have a financial benefit in urging you to perform more imaging/diagnostic procedures.

When deciding whether or not to perform further imaging/diagnostic procedures, we would advise you to seek answers to the following:

  • What is the purpose of the procedure? For example, is it to arrive at a diagnosis, assess treatment response, or is it preventive screening?
  • Are there alternative imaging procedures that could accomplish the same goal without medical radiation, such as ultrasound or magnetic resonance imaging?
  • What are the risks of not having the imaging procedure done?
  • What is your radiation exposure from previous medical procedures? For example, have you undergone multiple CT or nuclear medicine scans in the past?

Each time you are asked to do a CT Scan/PET Scan, be aware of the amount of radiation that would be bombarding your body and do remember that the radiation is accumulative i.e. it accumulates in your body, not the doctor’s body (except his wallet gets heavier). The following article is self explanatory:

Medical Bankruptcy in the US

After reading Steven Brill article, Bitter Pill: Why medical bills are killing us (Time magazine, 20 February 2013) I started to surf the Internet and posed some questions. Let me share with you what I found.

Frederick Allen of Forbes wrote an article: The Reason American Health Care Is Out Of Control http://www.forbes.com/sites/frederickallen/2013/03/05/the-reason-american-health-care-is-out-of-control/

This is what he wrote:

Steven Brill’s Time magazine cover story last week on health care got a lot of attention for its tracking of astronomical costs in American health care back to their sources. But why are those costs so high anyway? Is it because an unfettered free market is not allowed to work when it comes to health and medicine? Quite to the contrary.  It’s partly because an unfettered free market cannot work when it comes to health and medicine … a free market can’t control those costs. It can only distort and encourage them. It makes them worse. And it isn’t even really a free market.

As Steve Brill wrote: Everyone along the supply chain—from hospital administrators (who enjoy multimillion-dollar salaries) to the salesmen, executives and shareholders of drug and equipment makers—was reaping a bonanza.

And the only free-market choice I could make at this point to bring way down my own astronomical medical costs would be the choice that was so famously given to Jack Benny: Your money or your life.

Two readers responded to Frederick Allen’s article:

  • Doctors in the US have a very powerful cartel restricting the supply of new doctors – medical school slots and residency positions are not increasing due to the demographic-driven demand. Mid-level providers (Nurse Practitioners and Physician Assistants) help meet the demand; but the barriers to becoming a doctor can’t help control prices.
  • It is very true that people shall pay anything for preserving life! This very compulsion of a patient, is exploited by everyone in the medical sector where there exists nexus between doctors and insurance companies on one hand and on the other hand another nexus exists between pharmaceutical companies and medical clinics/doctors. In their greed to milk a needy patient, every means is employed to make him pay for extremely exorbitant prices for medicines even though cheaper substitutes could be available. There must be some accountability in such matters. Medical profession has turned out to be an extremely lucrative profession in the present times. If patients are left a choice to shop for buying the prescribed medicines from adjoining Canada or Mexico, they would get exactly same named prescribed medicine, manufactured by the same company, at a much cheaper rate over there. The US. Federal government rather should give a choice to those patients who can procure those prescribed medicines at cheaper rates from Canada/Mexico etc.

I typed this question in Google search: Is the US healthcare cost-effective?

The US healthcare system is one of the least cost-effective in reducing mortality rates; while the United Kingdom is among the most cost-effective, according to a recent study published in the July issue of Journal of the Royal Society of Medicine Short Reports. The study compared the United States, United Kingdom, and 17 Western countries’ efficiency and effectiveness in reducing mortality over a 25-year period. The greatest cost-effectiveness  was found for Ireland, United Kingdom, and New Zealand  and the  least cost effective, were found for Portugal, Switzerland, and the United States.

Read more: http://formularyjournal.modernmedicine.com/news/us-healthcare-system-among-least-cost-effective-reducing-mortality

Umair Haque, Director of Havas Media Labs and author of Betterness: Economics for Humans  wrote:

  • Unless you’ve been living under a rock, you’ve heard by now that, where the majority of developed countries spend between 8–10% of GDP on health, America spends ~16%. Per capita healthcare costs in the States have significantly outstripped costs in other countries.
  • Why has healthcare expenditure exploded? Each component of healthcare spending has grown — but the fastest growth has come from prescription drug spending. Where people in other developed countries spend between $400 and $500, Americans spend almost $900 per capita on pharmaceuticals.
  • Americans receive less care than their counterparts in other developed nations. The US has the lowest number of hospital beds per 1,000 people amongst developed countries. And it has the smallest number of doctor consultations per capita — just 3.8, compared to Canada’s 5.8, or Germany’s 7.4.
  •  Americans pay more for healthcare because they trade more expensive products for less service, realizing poorer outcomes. Why? Because that is what maximizes near-term profits along the value chain.

1-Profit-of-pharma

 Read more: http://blogs.hbr.org/haque/2009/08/how_to_think_constructively_ab.html

I typed this question in Google search: Is the US healthcare compassionate?

Rick Nauert, in an article: Compassion Missing in American Health Care wrote: Compassionate care is defined by the following four essential characteristics:

1. Empathy, emotional support, and a desire to relieve a patient’s distress and suffering.
2. Effective communication at all stages of a patient’s illness and treatment.
3. Respecting patients’ and families’ desires to participate in making health care decisions.
4. Knowing and relating to the patient as a whole person, not just a disease.

Compassion is as important in helping patients manage chronic and acute conditions as it is at the end of life. To improve quality and reduce costs, compassion should be present in all aspects of our healthcare system.

The survey found that only 53 percent of patients and 58 percent of doctors rate the U.S. healthcare system as a compassionate one.  Problems with the U.S. health care system include escalating costs, medical errors, inconsistent results and, according to a new national survey, a lack of compassion.

Read more: http://psychcentral.com/news/2011/09/09/compassion-missing-in-american-health-care/29295.html

Gordon Marino, professor of philosophy at St. Olaf College  wroteThe real US healthcare issue: compassion deficiency. Americans suffer from a compassion deficiency.

Read more: http://www.csmonitor.com/Commentary/Opinion/2009/0813/p09s01-coop.html 

I typed this question in Google search: Is the US healthcare money driven?

There is a movie –  Money-Driven Medicine –  produced by Academy Award winner Alex Gibney (Taxi to the Dark Side, etc.) and inspired by Maggie Mahar’s acclaimed book, Money Driven Medicine: The Real Reason Health Care Costs So Much.  The message of this movie:

  • The U.S. spends twice as much per person on healthcare as the average developed nation,  yet our outcomes, especially for chronic diseases, are very often worse.
  • What makes us the exception? The U.S. is the only industrialized nation that has chosen to turn medicine into a largely unregulated, for-profit business.
  • Dr. Donald Berwick, Administrator of the Centers for Medicare and Medicaid Services, explains: We get more care, but not better care.
  • Medical ethicist Larry Churchill doesn’t mince words: The current medical care system is not designed to meet the health needs of the population. It is designed to protect the interests of insurance companies, pharmaceutical firms, and to a certain extent organized medicine. It is designed to turn a profit. It is designed to meet the needs of the people in power.
  • As the eye-opening ads in Money-Driven Medicine reveal, the more new drugs, surgical procedures, diagnostic devices and hospital beds the health industry can produce, the more they can sell – whether we need them or not. It’s called “supply-driven demand” and it’s possible because a sick consumer can’t say no.

Read more: http://moneydrivenmedicine.org/about-mdm

In another article: 50 Signs That The U.S. Health Care System Is A Gigantic Money Making Scam That Is About To Collapse, the author wrote:

  • The U.S. healthcare system is a giant money making scam that is designed to drain as much money as possible out of all of us before we die.
  • In the United States today, the healthcare industry is completely dominated by government bureaucrats, health insurance companies and pharmaceutical corporations.  The pharmaceutical corporations spend billions of dollars to convince all of us to become dependent on their legal drugs, the health insurance companies make billions of dollars by providing as little health care as possible, and they both spend millions of dollars to make sure that our politicians in Washington D.C. keep the gravy train rolling.
  • Healthcare costs continue to go up rapidly, the level of care that we are receiving continues to go down, and every move that our politicians make just seems to make all of our healthcare problems even worse.
  • In America today, a single trip to the emergency room can easily cost you $100,000, and if you happen to get cancer you could end up with medical bills in excess of a million dollars.
  • Even if you do have health insurance, there are usually limits on your coverage, and the truth is that just a single major illness is often enough to push most American families into bankruptcy.  At the same time, hospital administrators, pharmaceutical corporations and health insurance company executives are absolutely swimming in huge mountains of cash.

Read more: http://theeconomiccollapseblog.com/archives/50-signs-that-the-u-s-health-care-system-is-a-gigantic-money-making-scam-that-is-about-to-collapse

 I typed this in Google search:  Are Americans going bankrupt due to medical bill?

David U. Himmelstein, MD; Deborah Thorne, PhD; Elizabeth Warren, JD; and Steffie Woolhandler, MD, MPH are from the Department of Medicine, Cambridge Hospital/Harvard Medical School, Department of Sociology, Ohio University and Harvard Law School. They published their study: Medical bankruptcy in the United States, 2007 in the American Journal of Medicine, http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf

 

What did they say? In 1981, only 8% of families filed for bankruptcy due to serious medical problem. In 2001, the author’s study showed that at least 46.2% of all bankruptcies were due to medical problems. In 2007, 62.1% of all bankruptcies were because of medical problems.

The shocking discovery: Most medical debtors were well educated, own homes and had middle class occupations. Three quarters had health insurance.

What has gone wrong? High medical bills directly contributed to their bankruptcy. Many families with continuous coverage found themselves under-insured, responsible for thousands of dollars in out-of-pocket costs. Others had private coverage but lost it when they became too sick to work. Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year.

The authors concluded: The US healthcare financing system is broken.

CNN carried this report: Medical bills prompt more than 60 percent of U.S. bankruptcies. This year, an estimated 1.5 million Americans will declare bankruptcy. Many people may chalk up that misfortune to overspending or a lavish lifestyle, but a new study suggests that more than 60 percent of people who go bankrupt are actually capsized by medical bills. Bankruptcies due to medical bills increased by nearly 50 percent in a six-year period,

Read more: http://articles.cnn.com/2009-06-05/health/bankruptcy.medical.bills_1_medical-bills-bankruptcies-health-insurance?_s=PM:HEALTH

Reuters had this report: Medical bills underlie 60 percent of U.S. bankrupts: study. According to this report, medical bills are behind more than 60 percent of U.S. personal bankruptcies … healthcare reform is on the wrong track. More than 75 percent of these bankrupt families had health insurance but still were overwhelmed by their medical debts.

Dr. David Himmelstein of Harvard University said: Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy…For middle-class Americans, health insurance offers little protection.

http://www.reuters.com/article/2009/06/04/us-healthcare-bankruptcy-idUSTRE5530Y020090604

In the New York Times, Medical Bills Cause Most Bankruptcies, Tara Parket-Pope wrote:  Nearly two out of three bankruptcies stem from medical bills, and even people with health insurance face financial disaster if they experience a serious illness. The U.S. health care financing system is broken, and not only for the poor and uninsured,” the study authors wrote. “Middle-class families frequently collapse under the strain of a health care system that treats physical wounds, but often inflicts fiscal ones.

http://well.blogs.nytimes.com/2009/06/04/medical-bills-cause-most-bankruptcies/

Brennan Keller wrote in his blog: A new study done by Harvard University suggests that more than 62% of all personal bankruptcies are caused by the cost of over-whelming medical expenses. Of the most financially devastating diseases, cancer reigns supreme.

Read more: http://www.giveforward.com/blog/medical-expenses-top-cause-of-bankruptcy-in-the-united-states

Professor of Political Science, University of Missouri-St. Louis, Dr. Kenneth Thomas wrote: Medical Costs Help Drive United States to Highest Bankruptcy Rate in OECD.  A study published in the American Journal of Medicine shows that there was a sharp increase in the proportion of bankruptcies with significant medical causes (defined as debts over $5,000, loss of income due to health problems, or mortgaging of the debtor’s home to help meet medical expenses) between 2001 and 2007. According to their study, 46.2% of bankruptcies in 2001 were medically-related, while by 2007 the level had grown to 62.1%.

1-Bankcrupcy

http://middleclasspoliticaleconomist.blogspot.com/2012/02/medical-costs-help-drive-united-states.html

As expected, in any democratic country, there are always people who would dispute every scientific finding. Sally Pipes in her article: Medical bankruptcy: Fact or fiction?  http://thehill.com/blogs/congress-blog/economy-a-budget/263547-the-myth-of-medical-bankruptcy#ixzz2NHrAoqfD  wrote:

  • This year, a whopping 1.25 million Americans are expected to file for bankruptcy. Ask the president and his allies whom to blame, and they’ll point to healthcare. President Obama has claimed that the cost of healthcare causes a bankruptcy every 30 seconds.
  • But the alleged link between health costs and bankruptcy is about as real as the tooth fairy. The overwhelming body of research shows that medical costs play little or no role in the vast majority of U.S. personal bankruptcies.
  • Proponents of the health-cost-bankruptcy theory tend to cite a Harvard study that blames high medical bills for some 62 percent of American bankruptcies.
  • A study published in the journal Health Affairs reviewed Justice Department data and discovered that among Americans who cited medical debt as a contributing factor in their bankruptcy filing, only 12 to 13 percent of their total debts were medical.
  • The study also found that medical spending was a factor in no more than 17 percent of U.S. bankruptcies.
  • Too many Americans go bankrupt each year. But contrary to the claims … the cost of healthcare is not to blame. 

You can agree or disagree with what Sally Pipes wrote, but let me ask you to read again the article: Are medical bills killing patients?  $83,900 (approx: RM 251,700) the initial cost of a lymphoma treatment, or $902,452  (approx: RM 2.2 million) for treatment of lung cancer for 11 months before the patient died.

With that kind of medical bills, who would not go bankrupt?

As I surfed the internet further, I came across many shocking facts – I asked myself:  How not to go bankrupt with things like this happened?

The tab for medical care can add up quickly. Take a breast cancer diagnosis, for example.

  • A  breast cancer diagnosis bill can easily top $25,000.
  • A bilateral mammogram costs about $270.
  • A biopsy to test a suspicious area costs about $1,070.
  • A total mastectomy would cost about $11,500.
  • If the patient needs chemotherapy, a four-day hospitalization for treatment will run about $13,400.
  • Add another $260 per radiation treatment.

http://www.columbian.com/news/2012/nov/04/medical-bills-lead-many-families-to-file-for-bankr/

here are two interesting comments  in response to Towering Medical Bills Leave Many Americans Bankrupt:

  • This is written in loving memory of a couple I knew for decades. She suffered a lifetime with bi-polar. To pay for the expensive drugs not covered, he re-mortgaged. After retirement he could no longer keep up. The night before their foreclosure, he shot her and their border collie (dog) and out of grief torched their house. He is now serving life. The collie was killed “because he would have died of a broken heart”. Whenever I think of how inhuman our health care non-system is, my heart breaks again.
  • Our 25 year old son could not afford health insurance and it wasn’t provided at the restaurant where he worked. He had a serious accident which resulted in extensive third degree burns on his right hand, arm and leg. He was in the burn unit in Buffalo, NY for two weeks, underwent skin grafts and physical therapy to regain the use of his right hand and fingers. He ran up over 50K of medical bills but did not declare bankruptcy-because of the stigma. Now he is crippled by medical bills, cannot afford a car, his own apartment, or health insurance on his income. I don’t see how he will be able to recover from this and ever afford to have a family. 

Read more: http://www.npr.org/templates/story/story.php?storyId=105193107

  • When a Medicine (Revlimid) “Works” It’s Unaffordable: $132,000/year, $534/pill (This is RM 1,650 per pill) :  After making more than 70 phone calls to 16 organizations over the past few weeks, I’m still not totally sure what I will owe for my Revlimid, a derivative of thalidomide that is keeping my multiple myeloma in check. The drug is extremely expensive — about $11,000 retail for a four-week supply, $132,000 a year, $524 a pill. 
  • While drug companies spend a great deal to develop medications, their costs are inflated and overstated.  Efficiency is simply not on their agenda.  Nor is patient well being, access or for that matter outcomes. It’s the money stupid!  Charging more than twice the median U.S. income for a single drug that patients in life-threatening situation, any single drug, is simple blackmail.  It reflects an industry and economy gone mad. 
  • I had a friend who was on Revlimid for a pre leukemia condition. He was shocked when I told him what the cost was. The drug also has some very nasty side effects. Despite the treatment, he died a few months after starting it. 

Read more: http://medicynic.com/2012/12/09/and-when-a-medicine-revlimid-works-its-unaffordable-132000year-534pill/

  • Cabozantinib: A Miracle Cancer Drug without Survival Benefit:  The FDA recently approved cabozantinib for use in medullary thyroid cancer that has metastasized.  What’s noteworthy about this drug is that it will likely be very expensive and that it does not, repeat does not improve the patient’s survival – No statistically significant difference in overall survival.
  • Cometriq contains a Boxed Warning, telling doctors and patients about the risks of severe and fatal bleedings and perforations and fistula in the colon.
  • Other new miracle agents often have limited efficacy with say two months median survival improvement.  But this is the first such drug being actively promoted, that I can recall, that has no survival benefit. Maybe this is yet another reason we spend more on healthcare than any other country in the world.  

Read more: http://medicynic.com/2012/12/04/cabozantinib-another-miracle-cancer-drug-without-survival-benefit/

Read also: 

  1. The high cost of staying alive in a private hospital  https://cancercaremalaysia.com/2012/11/13/part-1-the-high-cost-of-staying-alive-in-a-private-hospital/
  2. Die of cancer but don’t die a bankrupt  https://cancercaremalaysia.com/2012/12/14/die-of-cancer-but-dont-die-a-bankrupt/
  3. How much life is worth  https://cancercaremalaysia.com/2011/05/27/dissecting-chemotherapy-part-4-how-much-is-life-worth-erbitux-for-lung-cancer/
  4. Money driven medicine  https://cancercaremalaysia.com/2011/09/02/book-review-money-driven-medicine-%E2%80%93-chemotherapy-for-non-responsive-cancers-%E2%80%93-denying-reality/
  5. Avastin does not cure cancer https://cancercaremalaysia.com/2011/05/27/dissecting-chemotherapy-part-6-avastin-does-not-cure-cancer/

 

 

Are Medical Bills Killing Patients?

Again please?

Medical bills are killing patients?

Yes, medical bills are killing you!

Do I hear it right?

Medical bills are killing you?

But I am sick! Should it not be the disease that is killing me?

You bet!

Times Magazine of 20 February 2013, carried a lengthy article by Steven Brill: Bitter Pill – Why Medical Bills Are Killing Us. I printed out this article – there are 46 pages in all!

You can read the original article here: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2MjdpIcGO

These are some mind-boggling things that are happening in the hospitals in America today (passages extracted from the said article).

  • 1. Initial Lymphoma Treatment at MDA: $83,900 (approx: RM 251,700)

Sean Recchi, 42-year-old, was diagnosed with non-Hodgkin’s lymphoma. He went to MD Anderson (MDA) Cancer Center in Houston, Texas.

  • Just to be examined for six days so a treatment plan could be devised:  $48,900 to be paid in advance.
  • Sean’s treatment plan and initial doses of chemotherapy was $83,900.
  • Every time a nurse drew blood, the charge was $36.00, accompanied by charges of $23 to $78 for each of a dozen or more lab analyses performed on the blood sample. In all, the charges for blood and other lab tests done amounted to more than $15,000.
  • An injection of 660 mg of a cancer wonder drug called Rituxan was $13,702.
  •  “ALCOHOL PREP PAD” $7 each. This is a little square cotton used to apply alcohol to an injection area. A box of 200 can be bought online for $1.91.
  • Room charge:  $1,791-a-day.

Sean Recchi’s dose of Rituxan cost the Biogen Idec–Genentech partnership as little as $300 to make, test, package and ship. MD Anderson paid  $3,000 to $3,500 for this medicaton, whereupon the hospital sold it to Recchi for $13,702.

As 2013 began, Recchi was being treated back in Ohio because he could not pay MD Anderson for more than his initial treatment. As for the $13,702-a-dose Rituxan, it turns out that Biogen Idec’s partner Genentech has a charity-access program that Recchi’s Ohio doctor told him about that enabled him to get those treatments for free.

2.  False Alarm due to Indigestion: $21,000 (approx: RM 63,000)

Janice is a 64-year-old former sales clerk. She felt chest pains. She was brought by an ambulance to the emergency room at Stamford Hospital about four miles awa. After about three hours of tests and some brief encounters with a doctor, she was told she had indigestion and sent home. That was the good news. But the bad news were her medical bills …

  • The ambulance ride (four miles) came to $995.
  • $3,000 for the doctor and
  • $17,000 for the hospital.
  • In total she had to pay $21,000 for a false alarm.
  • An “NM MYO REST/SPEC EJCT MOT MUL” was billed at $7,997.54. That’s a stress test using a radioactive dye that is tracked by an X-ray or CT scan.
  • An additional $872.44 just for the dye used in the test.
  • The cardiologist in the emergency room gave Janice a separate bill for $600 to read the test results on top of the $342 he charged for examining her.

The regular stress test patients are more familiar with, in which arteries are monitored electronically with an electrocardiograph, would have cost far less — $1,200.

Stamford probably paid about $250,000 for the CT equipment in its operating room. It costs little to operate, so the more it can be used and billed, the quicker the hospital recovers its costs and begins profiting from its purchase. According to a McKinsey study of the medical marketplace, a typical piece of equipment will pay for itself in one year if it carries out just 10 to 15 procedures a day. That’s a terrific return on capital equipment that has an expected life span of seven to 10 years. And it means that after a year, every scan ordered by a doctor in the Stamford Hospital emergency room would mean pure profit, less maintenance costs, for the hospital. Plus an extra fee for the doctor.

The costs associated with high-tech tests are likely to accelerate. McKinsey found that the more CT and MRI scanners are out there, the more doctors use them. In 1997 there were fewer than 3,000 machines available, and they completed an average of 3,800 scans per year. By 2006 there were more than 10,000 in use, and they completed an average of 6,100 per year. According to a study in the Annals of Emergency Medicine, the use of CT scans in America’s emergency rooms has more than quadrupled in recent decades.

The dynamics of the medical marketplace seem to be such that the advance of technology has made medical care more expensive, not less. First, it appears to encourage more procedures and treatment by making them easier and more convenient.

  • 3. A Fall Cost Her $9,400 (approx: approx: RM 28,200) in Medical Bills

Emilia Gilbert is a school-bus driver.  In June 2008 she slipped and fell on her face one summer evening in the small yard behind her house. Her nose was  bleeding heavily and she was taken to the emergency room at Bridgeport Hospital. Gilbert said: I was there for maybe six hours, until midnight and most of it was spent waiting. I saw the resident for maybe 15 minutes, but I got a lot of tests. In fact, Gilbert got three CT scans — of her head, her chest and her face.

  • The CT bills alone were $6,538.
  • A doctor charged $261 to read the scans.
  • Gilbert’s total bill was $9,418 (approx. RM 28,200).

4. One-Day Outpatient Bill, $87,000 (approx: RM 261,000)

Steve, a blue collar worker, was in his 30s at the time and worked at a local retail store. He spent the day at Mercy Hospital in Oklahoma City getting his aching back fixed. He was told that a stimulator would have to be surgically implanted in his back. The good news was that with all the advances of modern technology, the whole process could be done in a day.

  • The Medtronic stimulator cost  $49,237.
  • Basic medical and surgical supplies was $7,882.
  • Bacitracin cost $108. This is a common antibiotic ointment.
  • His total bill was $86,951 (approx. RM 261,000).

Steve ’s bill for his day at Mercy contained all the usual and customary overcharges.

  •  “MARKER SKIN REG TIP RULER” for $3. That’s the marking pen, presumably reusable, that marked the place on Steve’s back where the incision was to go.
  •  “STRAP OR TABLE 8X27 IN” for $31. That’s the strap used to hold Steve onto the operating table.
  • Yet another item, “BLNKT WARM UPPER BDY 42268” for $32. That’s a blanket used to keep surgery patients warm. It is, of course, reusable, and it’s available new on eBay for $13.
  • “GOWN SURG ULTRA XLG 95121” for $39, which is the gown the surgeon wore. Thirty of them can be bought online for $180.

5. Medical Treatment for Stage 4 Lung Cancer: $902,452  (approx: RM 2.2 million)

This is a case of Steven and his wife Alice. Alice makes about $40,000 a year running a child-care center in her home. In January 2011, Steven was diagnosed with Stage 4 lung cancer. The couple knew that they were only buying time now. The crushing question was: How much is time really worth?

Steven died after 11 months of medical treatment at Seton Medical Centre in Daly, California. His wife, Alice had collected his medical bills totaling $902,452 (approx: RM 2.2 million). Alice said:  [Steven] kept saying he wanted every last minute he could get, no matter what. But I had to be thinking about the cost and how all this debt would leave me and my daughter.

Among the items charged in the bills were:

  • $18 each for 88 diabetes-test strips that Amazon sells in boxes of 50 for $27.85;
  • $24 each for 19 niacin pills that are sold in drugstores for about a nickel apiece.
  • Four boxes of sterile gauze pads for $77 each.
  • Intensive-care unit for two days at $13,225 a day.
  • 12 days in the critical unit at $7,315 a day and
  • Total room charges totaled $120,116 over 15 days.
  • $20,886 for CT scans and
  •  $24,251 for lab work.

As 2012 closed, Alice had paid out part of the bills and still owed $142,000 —I think about the $142,000 all the time. It just hangs over my head, she said in December. One lesson she has learned, she adds: I’m never going to remarry. I can’t risk the liability.  In early February, Alice told TIME that she had recently eliminated most of the debt through proceeds from the sale of a small farm in Oklahoma her husband had inherited.

  • 6.  Pneumonia Treatment for $474,064 (approx: RM 1.42 million)

Rebecca and Scott are both in their 50s. On March 4, Scott started having trouble breathing. By dinner time he was gasping violently as Rebecca raced him to the emergency room at the University of Texas Southwestern Medical Center. Both Rebecca and her husband thought he was about to die, Rebecca recalls.

Scott was in the hospital for 32 days before his pneumonia was brought under control. Rebecca recalls that “on about the fourth or fifth day … the medical bill was over $80,000! When Scott checked out, his 161-page bill was $474,064.

  • The top billing categories were $73,376 for Scott’s room ( at $2,293 a day).
  • $94,799 for “RESP SERVICES,” which mostly meant supplying Scott with oxygen and testing his breathing and
  • $134 per day  for supervising oxygen inhalation
  • “SODIUM CHLORIDE  9%”  cost  $84 to $134. He used dozens of this. That’s a standard saline solution probably used intravenously in this case to maintain Scott’s water and salt levels. (It is also used to wet contact lenses.) You can buy a liter of the hospital version (bagged for intravenous use) online for $5.16.
  • $132,303 charge for “LABORATORY,” which included hundreds of blood and urine tests ranging from $30 to $333 each.
  • $24 per 500-mg tablet of niacin. In drugstores, the pills go for about a nickel each.

7.  Immune Booster Shot That Cost $ 7,346 (Approx: RM 22,000) Every 6 Weeks

About a decade ago, Alan  was diagnosed with non-Hodgkin’s lymphoma. He was 78, and his doctors in New Jersey told him there was little they could do. Through a family friend, he got an appointment with one of the lymphoma specialists at Sloan-Kettering. That doctor told Alan he was willing to try a new chemotherapy regimen on him. The treatment worked.  A decade later, Alan is still in remission. He now travels to Sloan-Kettering every six weeks to be examined by the doctor who saved his life and to get a transfusion of Flebogamma, a drug that bucks up his immune system.

  • Sloan-Kettering’s bill for the transfusion is about $7,006.
  • In addition he had to pay the doctor $340 for a session.
  • Each  visit cost a total of $7,346.
  • Assuming eight visits (but only four with the doctor), that makes the annual bill $57,408 (This is approximately RM 172,224) a year to keep Alan alive.

Two basic Sloan-Kettering charges are $414 per hour for five hours of nurse time for administering the Flebogamma and a $4,615 charge for the Flebogamma.

According to Alan, the nurse generally handles three or four patients at a time. That would mean Sloan-Kettering is billing more than $1,200 an hour for that nurse.

Flebogamma’s Profit Margin:  Made from human plasma, Flebogamma is a sterilized solution that is intended to boost the immune system. Sloan-Kettering buys it from either Baxter International in the U.S. or a Barcelona-based company called Grifols.

  • The Flebogamma dose for Alan — “can’t cost them more than $200 or $300 to collect, process, test and ship.”
  • Sloan-Kettering bought this dose from Grifols for $1,400 or $1,500 and charged Alan $4,615 for it!

These are some questions posed by the author:

  • What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab?
  • Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college?
  • What makes a single dose of even the most wonderful wonder drug cost thousands of dollars?
  • Why does simple lab work done during a few days in a hospital cost more than a car?
  • And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2MjdpIcGO

My Last Word

This is American – the land where people have great dreams!  In the 1970s, I did my Ph.D. in that great country with the generosity of the US government. Then my two children went to the US to do their Ph.Ds – also courtesy of the American people.  Thank you!

America is a great country – to study and to work in, but it sadden me to know that it is not a great country for the sick – especially if one is not adequately covered by medical insurance as this article tells us.  In my next article on medical bankruptcy the situation is even more depressing.

You may ask me why I try to poke my nose into the “domestic” affairs of the US.  The reality is, what is happening in the US today can also happen in this part of our world! Better that we know now what is going on and be well prepared for a rude shock!

One patient with pancreatic cancer went to see an oncologist. She spent about 10 minutes consulting him and was charged S$700 (that is RM 1,700 – the pay of an average worker for a month!). What was she told during that ten-minute-encounter? Read her story here: https://cancercaremalaysia.com/2012/05/29/part-1-an-encounter-with-an-oncologist-a-great-disappointment/

But S$700 is already cheap! Read this story: Breast cancer: She died even after a multi-million dollar medical bill  https://cancercaremalaysia.com/2011/03/01/breast-cancer-she-died-even-after-multi-million-dollar-medical-bill/

The question under discussion is, what is a fair and reasonable fee a renown doctor can charge his/her patient? These are the figures given by the various medical doctors of Singapore:

  • Dr. Hong Ga Sze  said a reasonable daily fee is $1,000 to $2,000 per day.
  • Dr. Tan Yew Oo, oncologist at Gleneagles Cancer Centre said $10,000 to $20,000 per day.
  • Professor Soo Khee Chee, head of the National Cancer Centre said $100,000 a day is fine and agreed that on a day Dr. Susan Lim could have charged as much as $450,000 per day.

The husband of a patient spent about 2 billion rupiahs for the treatment of his wife’s cancer without success. During our conversation he told me that he was billed S$120 (RM 300) each time his wife sat on the chair in the clinic to receive the chemotherapy drip.

You can read more stories here:

  1. Fancy gadget and half a million ringgit failed to cure her https://cancercaremalaysia.com/2011/01/29/breast-cancer-fancy-gadget-and-half-a-million-ringgit-failed-to-cure-her-%E2%80%93-what-now/
  2. She almost died after spending two billion rupiahs on chemotherapy in Singapore https://cancercaremalaysia.com/2011/12/27/utero-ovary-lungs-cancer-part-1-she-almost-died-after-spending-two-billion-rupiahs-on-chemotherapy-in-singapore/
  3. Surgery-27 cycles of chemo and S$100,000 did not cure her https://cancercaremalaysia.com/2012/01/11/colon-lung-cancer-surgery-twenty-seven-cycles-of-chemo-and-sgd-100000-did-not-cure-her/

Let me close with this quotation by Daniel Taylor:  Medical tyranny is here, and we can’t say we weren’t warned http://www.oldthinkernews.com/2012/11/benjamin-rush-medical-freedom/  Benjamin Rush, one of the signers of the Declaration of Independence, warned in 1787 that medical freedom needed to be included in the American Constitution. Without this protection, Rush warned that the medical establishment would naturally progress – as many of mankind’s institutions do – into an oppressive dictatorship. His words, echoing from over 200 years ago, ring strikingly true today: The Constitution of this Republic should make special provision for medical freedom. To restrict the art of healing to one class will constitute the Bastille of medical science. All such laws are un-American and despotic. … Unless we put medical freedom into the constitution the time will come when medicine will organize into an undercover dictatorship and force people who wish doctors and treatment of their own choice to submit to only what the dictating outfit offers.

Breaking News

As I was about to post this article, someone sent me the link to this article: 

NY, NJ AREA CARDIOLOGIST ADMITS RECORD $19M FRAUD

NEWARK, N.J. (AP) — A cardiologist with offices in New York and New Jersey has admitted taking part in a scheme that subjected thousands of patients to unnecessary tests and treatment and resulted in $19 million in bogus bills, what authorities call the largest case of health care fraud ever by a practitioner in either state.

Read more: http://hosted.ap.org/dynamic/stories/U/US_CARDIOLOGIST_MASSIVE_FRAUD?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT

 

Part 1: The High Cost of Staying Alive in a Private Hospital

This case study consists of three parts.

Part 2: Eleven to Nineteen Drugs A Day Could Not Cure Her – Rather Die Than Suffer More   

Part 3:The Last Option: CA Care Therapy After Chemotherapy Had Failed

This is a tragic story of MS, a single, 41-year-old lady from Jakarta.

In early May 2012, MS felt uncomfortable in her abdomen. She felt something moving inside. She went to see an internist in Jakarta. A blood test showed elevated CA 125 – more than 1400. MS was asked to go and see a gynaecologist. A ultrasound was done and the gynecologist told her to go home and pray. She was told consult an oncologist. MS went to see a doctor who treated her with semi—chemo injection.

I was rather curious and enquired more about this treatment! This treatment was provided by a “retired” medical doctor who sees many patients a day. MS was given a concoction of “semi-chemo’ injection every day for two months. For her diet, MS was allowed to take only broccoli juice, egg white (albumin) – 12 eggs a day (4 eggs, thrice a day), banana and pears. MS felt better for the first month of treatment. But in the second month she felt the food rather boring. Her abdomen became bloated.  In short, her condition worsened.

MS and her elder sister (MM) came to a private hospital in Penang for treatment in mid-August 2012. She stayed two weeks in Penang and received two cycles of chemotherapy.  She went home to Jakarta but did not get any better.

After three days in Jakarta her condition deteriorated (drop!) She was admitted into a hospital in Jakarta due to low albumin. Her abdomen became bigger in size.

On 28 August 2012 MS and MM came back to Penang again and was admitted into the same private hospital.  And she has been in this hospital up to this day – almost one and a half months.  While in Penang she received seven cycles of chemotherapy. According to MM, the family had already spent RM 100,000 but the patient was not getting any better – in reality MS’s condition had worsened.

Since the current chemo regimen failed, the oncologist suggested switching to another regimen consisted of Caelyx and Topotecan. She was told that this would not cure her, but could prolong her life by about six to eight months. This information shocked MM and triggered here to try and look for another option. MM told me that after a short prayer that night she went off to sleep. The next morning she went to the internet and searched for kanker ovarium. This was her first attempt to find information for herself.  There she found CA Care on the YouTube.

MM came to see us on 16 October 2012. She brought along a stack of medical bills but not much medical reports!

From her medical bills, I get to learn many things about staying in a private hospital.

1.  It is not cheap to stay alive

The total cost for a 41-day-stay in a private hospital in Penang is almost RM 86,000. This works out to about an average of RM 2,000 per day.

Daily Cost in Hospital RM (Ringgit Malaysia)
28 August 2012 3,932.70
29 August 2012 1,568.50
30 August 2012 1,436.20
31 August 2012 1,590.80
1 September 2012 2,065.20
2 September 2012 1,917.50
3 September 2012 2,006.00
4 September 2012 1,355.70
5 September 2012 1,723.90
6 September 2012 1,804.30
7 September 2012 1,609.80
8 September 2012 1,663.00
9 September 2012 1,618.30
10 September 2012 1,859.60
11 September 2012 2,459.80
12 September 2012 1,592.50
13 September 2012 1,220.50
14 September 2012 2,999.70
15 September 2012 1,264.50
16 September 2012 1,531.50
17 September 2012 1,178.00
18 September 2012 4,000.80
19 September 2012 2,389.80
20 September 2012 1,479.50
21 September 2012 4,041.70
22 September 2012 2,055.30
23 September 2012 1,856.60
24 September 2012 3,016.20
25 September 2012 2,826.20
26 September 2012 2,312.20
27 September 2012 3,036.10
28 September 2012 2,642.50
29 September 2012 2,164.60
30 September  2013 2,038.50
1 October 2012 2,108.10
2 October 2012 2,922.70
3 October 2012 2,605.40
4 October 2012 1,418.70
5 October 2012 1,664.80
6 October 2012 1,394.20
7 October 2012 1,014.40
Total cost of 41 days in hospital       85,386.30
Average cost  of hospital per day  2,082.59

 2.  The Most Expensive and Cheapest Seven Days in Hospital

At certain days the cost could be as high as RM 4,000 and the cheapest day is about RM 1,000

The most expensive 7 days in hospital  
21 September 2012 4,041.70
18 September 2012 4,000.80
28 August 2012 3,932.70
27 September 2012 3,036.10
24 September 2012 3,016.20
14 September 2012 2,999.70
2 October 2012 2,922.70
The cheapest 7 days in hospital  
4 October 2012 1,418.70
6 October 2012 1,394.20
4 September 2012 1,355.70
15 September 2012 1,264.50
13 September 2012 1,220.50
17 September 2012 1,178.00
7 October 2012 1,014.40

 3. What Makes A Hospital Stay Expensive?

The cost of a hospital stay consist of: room charge, doctors’ fees, nursing care, laboratory services, medical supplies, medication / pharmacy charges, procedures – dressing or nursing, X-ray and CT scan charges.

Laboratory services RM (Ringgit Malaysia)
CA 125 85.20
CA 19.9 85.20
Full blood picture 53.20
Liver Function Test 47.20
Creatinine 39.60
Prothrombin time (PT) 47.20
Cancer Treatment Monitoring Profile 220.40
Blood-screening and processing 304.00
Blood transfusion 100.00
 Imaging 
CT scan 880.00
X-ray Charges 800.00
Professional Services 
Doctor attendance fee 80.00
Dietetic for follow up 35.00
Nursing care 60.00
 Lodging & Physical Facilities
Lodger 20.00
Room – single 310.00
Regular meal – single room 60.00
Clinical waste 10.00
Ripple mattress 20.00

 4.  The Week of Chemotherapy in Hospital

The Week of Chemotherapy  
18 September 2012 4,000.80
19 September 2012 2,389.80
20 September 2012 1,479.50
21 September 2012 4,041.70
22 September 2012 2,055.30
23 September 2012 1,856.60
24 September 2012 3,016.20
Total cost for the week 18,839.90

 

On 18 September 2012 MS underwent chemotherapy.  The drugs used were Carboplatin and Intaxel (generic Indian paclitaxel). And these are the drugs that matters – trying to “kill” the cancer. Take note that the cost of Carboplatin and Intaxel are only RM 363.30 + RM 363.30. But the total cost for the day in hospital was RM 4,000.80. Just imagine, it would be most wonderful if Carboplatin + Intaxel were not toxic – treating cancer would be cheap and everyone could afford it! But the problem is, chemo drugs are toxic, i.e. poisonous! Because of that a lot of other drugs are needed to support and keep the patient alive! Study the details of the costs and types of drugs used for that day.

Itemised bill of 18 September 2012

After receiving the chemo injection, patients generally suffer side effects. Three days later the situation had probably become severe and the patient needed more support.  The total bill for the day shot up to RM 4,041.70. Then three days later, further support was needed and this time the bill came to RM 3,016.20

Itemised bill of 21 September 2012

Itemised bill of 24 September 2012

(For information on what these drugs are for, go to Part 2 of this story)

From the above, I learned that to administer a drug to “kill cancer” which costs only RM 363.30 + RM 363.30, patient had to spend more than RM 18,000 in the form of supporting drugs and services. Again I say, how nice it would have been if that RM363 + RM 363.30-chemo-drugs were not toxic to healthy cells. Then we don’t need all those supporting drugs and don’t have to incur all those additional costs.

Can someone “invent”, synthesize or make a drug for cancer that is entirely safe? Or it is AGAINST their vested interest to look into such a proposition? I am not naïve when I ask these questions.  Read the quotations below:

When you get into the hospital, know this ….

Pancreatic Cancer: Severe Pains and Died After PET Scan

Yoke (not real name, H-469) was a 54-year-old female. Sometime in October 2010, she had on and off pains in her abdomen. Later, the pains extended to her lumbar region. The pains deprived her of sleep. Yoke went to a private hospital for a checkup. Ultrasound, CT scan and blood tests were carried out.

Blood test showed CEA = 38.3 (high); CA 19.9 = 40,003.44 (high); Total bilirubin = 4.6 (low) and GGT = 72 (high).

Ultrasound done on 22 November 2010 showed: “hypoechoic lesion in the pancreatic body … measuring 5.8 x 4.4 x 2.6 cm. There are multiple, well-defined hypoechoic nodules in the liver – the largest seen in the right hepatic lobe, measuring 2.5 cm. Impression: pancreatic body hypoechoic mass is likely a neoplastic lesion with metastases in the liver.”

For confirmation, a CT scan was performed the next day, 23 November 2010. The report indicated: “hypodense mass on the body / tail of the pancreas – measuring approximately 6 x 3 cm. The second hypodense nodule … is also seen more distally in the pancreatic tail. There are a number of hypodense lesions in the liver – the largest lesions are in segment 8, measuring 2.5 cm each. Other lesions are in the caudate lobe, segment 7 and segment 5.

Impression: Carcinoma of the body and tail of pancreas with infiltration of the splenic vein, encasement of the roots of the portal vein and multiple hepatic metastases.

Surgery was not indicated in this case, since the cancer had already spread to her liver. The only option left was to undergo chemotherapy. Yoke was told that she needed to receive seven weekly cycles of chemotherapy. With such treatment, Yoke was told there would be a sixty percent chance of suppressing the cancer (whatever that means?). The oncologist also said that the smaller tumours would not spread after the chemo-treatment.

Yoke refused chemotherapy. She came to seek our help on 20 November 2010. She presented with the following:

  • Pain in the abdomen and lumbar region. She had to take the painkiller, Tramadol.
  • Unable to sleep if there were pains.
  • A bit tired.

She was prescribed Capsule A and B, LL-tea, Liver 1 and Liver 2 teas, Pancreas 1 and Pancreas 2 teas, and Pain Tea.

A week on the herbs: Yoke felt more “cheng sin” (more energetic). Her sleep improved. In the first four days taking the herbs, Yoke suffered the healing crisis. She had intense pains. But the pains gradually subsided and by the fifth day the pains were gone.

Two weeks on the herbs, 10 December 2010: Yoke informed us that she had totally stopped taking the Tramadol prescribed her doctor.  She did not have any more pains but she continued taking the Pain Tea. Her sleep was good. Her appetite improved.

Three weeks on the herbs, 17 December 2010: Yoke stopped taking the Pain Tea. And she did not suffer any pain. She said she was always felt hungry after taking the herbs. Our answer to this “problem” –  go ahead and eat!

Yoke appeared to be doing well with the herbs. She was then busy making arrangements for her daughter’s wedding. We did not get to see much of Yoke for some months even though we knew that she still continued taking our herbs.

About six months later, May 2011: Yoke came to our centre and she was in severe pains. Why and what had happened?

Yoke said her friend encouraged her to go for a PET scan in order to know what was going on inside her. After all she had been doing well. So Yoke went for a whole body PET/CT scan without seeking our advice. This procedure cost her RM 4,662.

Immediately after the procedure, Yoke suffered severe pains in her abdomen and lumbar region. It was back to the same old problem again.

Let Yoke explain what had gone wrong.

Our conversation

Chris: You went to do a PET scan?

Yoke: Yes and the doctor asked me to eat meat for two days.  I was told not to eat rice, fruits, juices and vegetables. I must eat only meat, egg, mushroom and porridge. I was asked to eat these for two days before I went for the scan.

Did he tell you why you need to do that?

So that the pictures would come out clearer.

Did you suffer after taking all these food?

Yes after I took meat, I started to have pains – more pains.

How much did you have to pay?

I put in RM 5,000 and I got back RM 338 (so the cost of her PET scan was RM4,662). If I knew  all these, I would not have gone for the scan. They asked me to eat meat for two days – damn it!

But why did you go and do it in the first place>

I have a group of cancer friends. They too went for PET scan. They told me CT scan is not clear and PET scan is clearer – you will know if the cancer is active or not.

So, you follow their advice?

Yes, I was real dumb and went for it.

There is no” meaning” for you to do that!

As you had said. I had pains after that and they could not “repair” me. I had more pains and I was also not able to sleep. More problems for me.

Daughter: They said the cancer had spread to the liver.

Yes, we already knew that anyway. And they asked you to take meat?

That was why the cancer became more active.

They Asked Me to Go for Chemotherapy

They asked me to go for chemo.  But the doctor said this was not going to cure me – only maintain. The doctor also said only 25 percent of patients who had chemo lived for two years. So I asked what happened to the remaining 75 percent – “went off”?  When the cancer recurs, I would need to do more chemo.  No, no – I told the doctor I do not want any chemo. When I told him that, he ignored me – not interested to talk to me anymore.

Let me ask you this – let’s assume that you have two years to live with chemo, and you only have one year if you take herbs. Why one would you choose?

I want to take herbs. May be I might just die sooner with the chemo. I told the doctor, “I might just die while undergoing chemotherapy.” He said, “No, no such thing. I would give you the drug bit by bit.” But I did not want to hear from him anymore.

She Died Soon Afterwards

After the PET scan, Yoke had pains and these got worse by the day. She was unable to sleep or walk by herself, and became weaker. Her stomach was bloated and she was in severe pain. Finally she died not long afterwards.

Information about PET scan from the Internet

  • X-ray, CT scan and MRI show the anatomy and structure of the organs examined. In contrast, PET scan reveals the metabolic activity and function of the organs. So, X-ray. CT and MRI scans assess the size and shape of different organs in the body. They do not assess function. While a PET scan looks at the body or organ function.
  • When we go for an X-ray, x-rays are generated from a machine and these rays go through our body and an image is formed on a film. In PET scan a radioactive material, called a radiopharmaceutical or radiotracer, is injected into our bloodstream. The commonly used radiotracer is fluorodexoyglucose (FDG). This is a glucose molecule which has been tagged with a small amount of radioactive element. The radioactive glucose is taken up by cancer cells. Tissues that are active accumulate a large amount of the radiotracer and they show up as “hot spots.” Thus, hot spots indicate high level of chemical or metabolic activity. Less intense areas, or “cold spots,” indicating a smaller concentration of radiotracer and less chemical activity.
  • PET scan is now considered a new technology. It helps doctors to locate the presence of cancer/infection anywhere in the body. Because cancers are multiplying and require energy for growth, PET scan is designed to detect any mass that is growing fast. The PET scan can also detect the spread of cancer in other parts of the body.

Do you learn any lesson from Yoke’s story?

Yoke learnt her lesson the hard way. Unfortunately it was too late. But can you learn any lesson from Yoke’s experience?

Ask these questions:

  1. The doctor asked Yoke to eat meat, eggs, etc., so that the “picture” will come out clear and nice? Do you know the reason for this after reading the information above? Was he not trying to “wake up the sleeping cancer cells” to make good pictures? It is good for him but this caused more harm to the patient.
  2. What is the “useful” purpose of doing the PET scan anyway – in this case?
  3. To have supportive friends is great but some can lead you to your doom. So before you embark on something, read first. If you cannot read – ask those who really know! 

Reflect on the quotations below:

When the Results of PET and CT Scans Do Not Tell the Same Story

About a year ago, a lady from a neighbouring country urgently flew to see me. She came to discuss the CT scan results of a VIP (very important personality).  The CT scan clearly stated that this VIP had tumours in his lungs and liver. His doctor suggested immediate surgery. This lady wanted my advice.

Just to be on the safe side, I suggested that it might be a good idea to know the extent of possible metastases – if at all there is any spread – before undergoing surgery. Towards this end, I suggested that he goes for a PET scan. At that time, my impression was that the PET is the state-of-the-art imaging procedure. It is more accurate and reliable than the CT scan.

After a few days, I was informed by phone that the PET done did not show any malignancy – no cancer!  Nevertheless, I hesitated to believe the result. At that time, I “interpreted” the message differently. I had the impression that this VIP wanted to avoid any dealing with me and therefore the only polite “save face” strategy was to tell me that there was no cancer. So he does not need my help anymore!

Some months later, I got to know through another person that this VIP had undergone a liver surgery. This planted the first seed of doubt in my mind about the reliability of PET scan.

Patient from Kelantan

In October 2011, I received a fax from a patient in Kelantan.  This 47-year-old male patient did a CT scan on 22 August 2011. The results indicated:

  • Three well-defined heterogenously hypodense small liver lesions in segments 2, 7 and 8. The largest in segment 2 measuring 0.7 x 1.0 cm. Foci of non-enhancing calcification seen in segment 8 with no mass effect, likely to represent old infection.
  • Small, well-defined lung nodule seen in the anterior segment of right upper lobe of 0.3 cm in diameter. A small pleural-based nodule is also seen in the posterior segment of left lower lobe measuring 0.3 cm in diameter.
  • Well-defined small sclerotic bony lesions see in at right acetabulum, left ilium and left neck of femur likely to represent bony island. Multilevel degenerative of the visualized spine.

Impression: Known case of sigmoid colon carcinoma with liver and lung metastases.

This same patient went to do a PET scan in Kuala Lumpur on 5 October 2011. The PET scan result indicated the following:

  • There is normal uptake in all the organs examined, in particular the colon, liver, lungs, lymph nodes, spleen, pancreas, kidneys, adrenal glands, brain and bones. There is no pleural effusion or ascites.

Impression: No malignant lesion is detected.

This was the second alarm bell. However, I did not take this episode to heart because the patient did not come to see me personally and I did not get to see the images of both the scans. As such I do not have any “solid” evidence to back up what I say – although I did have the faxed reports of both the procedures.

Patient from Penang

The third alarm bell – on 5 February 2012. A man came to our Centre with the medical reports of his wife who has ovarian cancer. She underwent surgery – TAHBSO (Total abdominal hysterectomy with bilateral salpingo-oophorectomy) – on 15 September 2010. This time I had the opportunity to examine the images of both the PET and CT scans.

Six months after the surgery, a PET scan was done at a private hospital in Selangor on 19 April 2011. 

Technique: PET scan was performed from the vertex of the skull to the thighs after intravenous administration of 8.5 mCi of F-18 Fluorodeoxyglucise (FDG). Oral gastrograffin, oral bromazepam and intra-venous lasix were given. Fasting blood glucose – 6.9 mmol/l/

Findings:

  1. Head – There is normal physiological localization of the FDG in the cerebrum and the cerebellum. The uptake and the distribution of the radiotracer in the posterior nasopharyngeal tissue, salivary gland and tonsils are within normal physiological limits.
  2. Neck –The thyroid gland displaces normal FDG upake. There is no FDG avid cervical lymphadenopathy. 
  3. Thorax – Normal FDG uptake is seen in both breasts. There is no FDG avid axillary lymphadenopathy, bilaterally. There is no FDG avid mediastinal lymphadenopathy. Thre is no pleural effusion seen.
  4. Abdomen – There is no suspicious FDG avid lesion see in the liver. U[take and distribution of the radiotracer in the gallbladder, spleen, adrenals, pancreas, kidneys and bowels are within normal physiological limits. There is no FDG avid abdominal lymphadeopathy. Ascites is not present.
  5. Pelvis – TAHBSO noted. There is no definite abnormal FDG lesion seen in the pelvic floor and vaginal stump. There are some superficial subcentimetre size non-FDG avid inguinal nodes which are likely to be reactive nodes. There is no FGD pelvic lymphadenopathy.
  6. Musculoskeletal – There is symmetrical FDG avid activity seen in the acromioclavicular joints bilaterally, probably due to imflammation. There is no suspicious FDG avid lesion seen in the visualized skeleton.

Conclusion;

  1. There is no evidence of residual hypermetabolic disease in the vaginal stump and pelvic floor.
  2. There is no evidence of hypermetabolic loco-regional or distant metastatic disease at present.
  3. Although there is no evidence of macroscopic disease at present, the presence of microscopic disease cannot be excluded.

The above report was signed by the Consultant Nuclear Medicine Physician.

Three months later, 25 July 2011, this same lady did an ultrasound of her abdomen and pelvis at the same private hospital in Selangor. The results indicated:

  • Mild ascites is seen.
  • A thick layer of lobulated parietal pleural masses are seen subdiaphragmatically, around the liver edges superiorly and laterally.
  • It measures up to 6 x 3.5 cm around segment 8 of the liver and 4.5 x3.7 cm superior to segment 2.
  • Intrahepatically, a hypoechoic nodule measuring 15 mm is noted in segment 3.
  • There are also intraperitoneal mesenteric deposit, measuring up to 3.6 x 2.8 cm in the right lumbar territory.
  • The uterus and ovary absent.

Impression: Extensive intraperitoneal metastases with ascites. Significant progression of the metastasis is seen.

On 16 November 2011, a CT scan of this same lady was done at a private hospital in Penang. The results indicated:

  • Extensive lobulated hypodense mass noted in the peritoneum and mesentery of upper abdomen.
  • The mass measured approximately 25 to 65 mm in diameter each.
  • The mass creep in between the diaphragm and the dome of the liver with marked subcapsular compression of liver.
  • Masses also noted in the lesser sac and the para-splenic space.
  • Moderate ascites.
  • Previous hysterectomy.

Impression: In view of the clinical history, features are consistent with relapsed of carcinoma of ovary with extensive peritoneal and omental metastasis.

Let me end with another story. There was this man who had stomach cancer. After surgery he came to seek our help and was started on the herbs. According to him, he felt good. He liked gardening and used to bring a lot of hot “cabai burung” whenever he came to our centre. He knew that I like hot chilly. One day this patient came and told us that he just had just done a scan and his doctor told him he had no more cancer – everything was clean. So he did not want to take any more herbs – after all the doctor said he was already cured! Although I did warn him that there is no such thing as a cure! No, his doctor’s words were more powerful and after all this was what every cancer patient wants to hear anyway.

A few months later, someone showed me his obituary in the newspaper. Besides learning that he was dead, I also learned that this man was a Datuk – a titled, respected personality in the community.

From the above stories, I learned that we can cause grave danger to patients by telling them things that they only want to hear. Or sending them for test that can give results that they are looking for –  of course, the more high-tech the equipment involved, the more convincing it would be.  So danger is not only confined to giving them the “wrong kind” of medication – the more toxic the more dangerous.

In this case the lady patient above had a choice – to believe that she had NO cancer after her surgery. What a great relief and welcoming news when the high tech state-of-the art technology similarly confirmed this belief. The lady also had another choice – to believe that surgery did not in any way cure her cancer and actually there were a lot more of the cancer cells left behind after the surgery! High tech gadget was unable to detect that but intuition and plain old-fashion experience is able to decipher that possibility.

Incidentally, while writing this article, I was also reading this humorous, oft-quoted all-time favorite book written by Dr. Oscar London, M.D., the pseudonym of an internist practising in Berkeley, California.