ONCOLOGY MALPRACTICE IN USA

Hello and welcome. I am Dr George Lundberg and this is At Large at Medscape.

Dr Joe Simone is one of the most respected of all American oncologists.^[1] Over a long career, he has served in leadership roles at St Jude Children's Research Hospital, Huntsman Cancer Institute, Memorial Sloan Kettering Cancer Center, the University of Florida Shands Cancer Center, the National Comprehensive Cancer Network, and the National Cancer Policy Board. Writing in the July 10, 2017, issue of Oncology Times, in "Simone's OncOpinion,"^[2] Dr Simone coined a new label, "econo-docs." Yes, it is pejorative.

He wrote:

Econo-docs often engage in behavior that is unprofessional at best and mired in unethical conflicts of interest at worst. A few examples (all of which I have observed) of such behavior follow:

• prescribing chemotherapy that is clearly futile ("churning");
• prescribing chemotherapy the oncologist sells to the patient at an exorbitant markup;
• ordering outpatients to receive costly IV hydration that is not indicated;
• using software programs to choose among drugs not by relative efficacy and safety, but by highest profit margin; and
• preferentially referring patients to other specialty services in which they personally hold equity positions that are hidden from the patient and the public, e.g., radiation oncology or diagnostic imaging facilities.

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I wish this were rare. I fear that it is not. If any of you dear readers are doing any of this, STOP IT, NOW. If you are a patient with cancer, a family member or friend, or another physician and you observe this behavior, do not let that physician get away with it. Call that physician out. In the words of Joseph Welch, chief counsel for the US Army, who famously confronted Wisconsin Senator Joseph McCarthy in Senate Hearings on June 9, 1954, "Have you left no sense of decency?"^[3]

Learned professionals such as physicians are supposed to be capable of self-governance, individually and as a group. Before a person may become a clinical oncologist, that person must first become a physician and thus is subject to the Principles of Medical Ethics. Principle II of the AMA Code of Medical Ethics^[4]states: "A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities."

Where are the state and county medical associations, the specialty societies? The American Society of Clinical Oncology (ASCO; disclosure: I am a member) lists an ethics committee and a membership committee. But when is the last time ASCO threw out a member for egregious, probably fraudulent, price-gouging of patients, insurance companies, or the government? I do not know. Does anyone?

Physicians rightly scream about the huge costs of new cancer drugs. But those drug companies do not pretend to be anything other than for-profit businesses. Medical organizations are notoriously weak in disciplining their members, and some physicians seem unable to resist the greed virus. Maybe that needs fixing. And when that happens, in the words of Bob Dylan, "it's a hard rain's a-gonna fall."

That is my opinion. I am Dr George Lundberg and this is At Large at Medscape.