OBR Daily Commentary

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The Change in Mammogram Guidelines

(Los Angeles Times) Mar 7, 2011 - After a federal panel pulled back its recommendations for screenings, a debate continues to rage about the wisdom or risk of it.

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Thomas Marsland, MD (Posted: March 09, 2011)

quotesThis certainly is an area of active debate. The key word in this is "routine". The decision to use screening mammography really needs to be individualized recognizing the patient's risk factors. It would be terrible if a patient with high risk was not screened because of this debate.quotes

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House Bill Introduced to Correct Medicare Drug Reimbursement

(Yahoo! Finance) Mar 3, 2011 - Members of Congress seek to reverse cancer care payment shortfalls; Community Oncology Alliance encourages speedy passage of bill.

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Thomas Marsland, MD (Posted: March 07, 2011)

quotesThis is a welcome bill. As the article says, the current ASP formula is flawed. Included in its calculations are the rebates paid to the wholesale distributors for their quick payment of bills to the drug manufacturers. These funds are not in anyway given to the providers. This bill has been proposed before and never passed. Hopefully it will pass this time, but in today's cost-cutting Congress I'm not optimistic. quotes

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Doctor-Owned Centers Spark Criticism, Scrutiny

(Washington Post) Feb 28, 2011 - When Kenneth Baker found out he had prostate cancer, his urologist detailed his options: The 84-year-old was too old for surgery, but he could pick from two forms of radiation or simply wait to see if he really needed treatment.

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Thomas Marsland, MD (Posted: March 02, 2011)

quotesAnother perfect case of doctors being guilty until proven innocent. Determining the optimal treatment for prostate cancer today is very complicated. There are many options. Surgery (traditional or robotic), Radiation (again with many options - IMRT, Protons, seeds) or Observation. The extent of the disease, patient's age, co-morbid conditions are all important in determining the best choices for a given patient. As we have seen recently from the Urologic meeting extensive research efforts are being undertaken to develop markers which will help decide which patients have aggressive disease and need more intensive therapy, and which patients have less invasive tumors and can safely have a less aggressive approach. Unfortunately the perfect test is still not readily available so I think patients will best benefit from a system where surgeons and radiation oncologists (and perhaps medical oncologists) can work together to coordinate the patient's care. To prohibit practices from providing this type of integrated care between urologist and radiation oncologist does the patient a disservice. Our practice combines urologist, radiation oncologist and medical oncologists. We feel that our patients are given the choices of what therapy (or no therapy) is best for them all provided by one group. Which modality offers the greatest reimbursement is NOT the determining factor in deciding what program is best for a given patient. We provide them all. We have found that by controlling all the aspects of care we can provide better quality and coordination of care. We also have imaging services within our practice (another program vilified by many). We have found that this improves the quality of the diagnostic test since the tests are preformed on the same machines, read by the same board certified radiologist who know what the needs of the oncologist really are and provide back to us in a timely fashion. Yes this generates some revenue for the practice but we also feel that the patient has had a better study. Indeed, as in all professions, there may be some places that perform studies or treatment to maximize profits but I believe that regulators should not place prohibition in place that could prevent the patients from receiving quality coordinated care.quotes

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Meet the Editorial Board

Prostate Cancer
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Tomasz M. Beer, MD, FACP

Professor of Medicine, Division of Hematology/Medical O...

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

Lung Cancer
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H. Jack West, MD

Medical Director, Thoracic Oncology Program, Swedish Ca...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Distinguished Professor of Medicine, Rutgers Robert Woo...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics
Pr...

Community Oncology
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Jeff Patton, M.D.

CEO Tennessee Oncology...

Precision Medicine Section Editor
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Jennifer Levin Carter, MD, MPH

Chief Medical Officer and Founder, N-of-One...

Financial Sector
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Michael G. King Jr.

Managing Director and Senior Biotechnology Analyst...

Gastrointestinal Cancers
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Richard Goldberg, MD

Director WVU Cancer Institute Director of Cancer Signa...

Editor-In-Chief
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Robert A. Figlin, MD., FACP

Professor and Director, Division of Hematology Oncology...

Health Policy
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Ted Okon

Executive Director Community Oncology Alliance...

Community Oncology
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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Community Oncology
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William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
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William McGivney, PhD

National Health Policy Expert...

Payer
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Winston Wong, PharmD

President, W-Squared Group...