CMS Unmoved By Clinicians But Persuaded by Paper

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  • 02/11/2008
Here's CMS Medical Director on the CMS policy to restrict ESAs in a one size fits all way:

The American Society of Clinical Oncology, which represents cancer doctors, and the drugs' makers, are continuing to submit new evidence to bolster their argument that the restrictions will boost the risk of blood transfusions, he said.


Straube said he has seen no convincing evidence to support reversing the decision. A recent poll released by cancer and blood doctors suggesting doctors believe the policy is leading to more blood transfusions will have little sway, he said.

That survey of about 500 oncologists and blood doctors asked about views on Medicare policy and its impact on care.

Straube said there is no evidence in properly controlled trials that blood transfusions could rise based on the policy.

"People don't use surveys to make national coverage decisions," he said. "These were opinions."

Straube said he was "disappointed" and surprised by the fervent reaction of the cancer doctor community.

"Our staff looked at over 800 evidenced-based articles published in the literature," he said. "I doubt seriously whether most clinicians read all 800."

Lest I incur the righteous wrath of Healthcare Renewal, let me restate what I found after going through all the evidence-based articles...

There is no evidence in properly controlled trials that blood transfusions won't rise nor that blood transfusions are safer or could be associated with less cancer. So why is the burden of proof on clinicians and patients? Similarly, where is the evidence that the additional risk of cancer -- the relative risk of which must be established in the context of the existing cancer under treatment and with the recognition that in all the properly conrolled trials excess mortality was not always associated with higher hemoglobin levels -- is not worth the benefit from the patient perspective?

According to Straube, the opinion of a patient or physician no longer counts. Only the judgement of staff who look at evidence-based articles matter. And as for those studies, there is no consistency in trial design, population size, tumor stage, etc. There is a lot of mixing and matching and none of those studies look at the safery and effectiveness of blood transfusions.

Is this how we want medicine to be paid for and practiced in the United States? Should we ignore individual differences in response to drugs and disease in favor of population based studies.

It's a pretty straightforward question. Let me know. Leave the ad hominem attacks out.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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