I have not read the Institute of Medicine report (which I will probably do) but I did read the article you linked to.
It seems like we’re putting the doctors between a rock and a hard place.
On the one hand, this article seems to be saying that our healthcare system is putting way too much time and money into hopeless cases. On the other hand, woe betide a doctor who says: “You have Stage IV melanoma with brain mets. Go home and prepare to die.” Melanoma treatments with “only” a 10% or 20% chance of working DO cure people. To me, it would be unethical for a doctor not to recommend one of those treatments. The costs/benefits approach to healthcare will always be a difficult issue.
I do very much agree with what the article says about taking more advantage of new technologies. People who live in small towns or in rural areas should not have to travel (at their own expense) to one of a few major treatment centers. Digital imaging, file sharing and teleconferencing should be more accessible so doctors all over the country can tap into the best melanoma experts in the country. That means, of course, that the insurance companies would have to pay for the doctors’ time to review and discuss cases remotely.
This article really resonates with me. I received Yervoy soon after it was FDA approved.
I honestly didn’t realize how lucky I was to be treated at Sloan Kettering, by an onc who had been part of the research and clinical trial process for the drug. My first onc was at another hospital, and he told me it was impossible that I could have had Mel again only 3months after he removed it. Needless to say, I never saw him again!
Unlike many, I had major gastro issues, and one day during an appointment, we were discussing how many small-town providers, (for lack of a better word) who were not familiar with melanoma or Yervoy, really didn’t know how to treat those and other side-effects. He said he was returning phone calls well into the night and on Saturdays trying to get those providers educated.
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