OBR Daily Commentary

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Non-Profit Drug Development Could Cut Cost of Cancer Medicines

(ICR [UK]) Feb 9, 2017 - Universities should work with new forms of commercial partner to take their own cancer drugs to market and drive down the ‘spiralling’ cost of new medicines, leading experts propose.

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Thomas Marsland, MD (Posted: February 16, 2017)

quotesThere is no free lunch (unfortunately). I would like to comment on actually two reports in today's OBR that reference Dr Workman's paper on "how much longer will we put up with $100,000 cancer drugs?" Clearly current drug pricing is unsustainable and if allowed to continue will ultimately result in limitation of access in some form. I am not sure that the idea of using academic centers would really lower the costs of development. There is little data to suggest they can do it more cheaply. The authors talk about partnering with private companies in the development process but clearly these companies are going to be looking for a return.... profit. Perhaps the expected returns may be less than traditional pharma but that remains to be seen. So some concepts that also perhaps need to be explored. I agree that the research process needs to be streamlined. With targeted treatments, as the authors suggested, one may not need the huge, expensive trials that have traditionally been done. It would be useful to look at drug costs in the approval process. If a new drug is not significantly more effective or less toxic then perhaps it should show a cost advantage to get approval. We need more transparency in how drugs are priced. Certainly what the "market will bare" is one large determinant now. How much of the cost is determined by marketing (direct to consumer ???, see prior comments) and not actual development. Allowing negotiations for the cost of drugs by the government would also be big step in controlling pricing. So clearly we need to do a better job of pricing cancer drugs. quotes

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Concerns That Rosy Direct-To-Consumer Ads Hype Cancer Drugs To Vulnerable Patients

(WBUR 90.9/CommonHealth [Boston, MA]) Jan 31, 2017 - An oncologist worries that rosy ads for new cancer drugs could raise the hopes of very vulnerable patients unrealistically.

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Thomas Marsland, MD (Posted: February 06, 2017)

quotesI am no fan of direct to consumer advertising. The article very nicely address a number of the reasons. Clearly no physician would not discuss the use of immune therapy in patients for whom it is indicated. On the other hand no one would order any treatment that isn't efficacious just because the patient saw it on TV. My question that has not been addressed is how much does this advertising add to the cost of the drug. Drug costs today are skyrocketing and although not clear to what degree but large marketing budgets certainly don't help cost controls. quotes

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Vantage Oncology’s 50 Centers and More Than 350 Affiliated Physicians Join The US Oncology Network

(Yahoo! Finance) Jan 26, 2017 - The US Oncology Network announced today, as part of McKesson Specialty Health’s ongoing integration with Vantage Oncology, that 50 centers in 13 states and more than 350 affiliated physicians have joined The Network.

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Thomas Marsland, MD (Posted: January 30, 2017)

quotesSo having the advantage of 35 years of practice has allowed me to see many different models of practice. I have been in a true multispecialty group, a small single specialty group, large corporate models (as being described), a large single specialty practice, and a large cancer focused multidisciplinary practice. The article leads off with a comment about "independent community based providers." My question is: "Is that model viable going forward?" Having watched my market evolve I am very skeptical that even with the power of a large national company that "independent community providers" will be around in the future. Certainly in some markets - yes. However what I have seen is the large hospitals form their own healthcare systems playing hard ball in a way that either you join them or they go out and bring in their own (non independent) oncologists. At best I see community docs as part of carved out joint venture with a local system (all politics are local as is healthcare delivery). Today even with a multidisciplinary cancer focused practice it is hard to provide all of the services: cancer prevention, diagnosis, treatment and support required. Many other specialties and supportive care providers are needed. Hospitals and "systems" are not going to let that business go. As one who grew up in the "buy and bill" days, I am saddened by these changes but we have to adapt and be involved for our patients and ourselves.quotes

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Meet the Editorial Board

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

Associate Cancer Center Director, Yale Cancer Center P...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Professor and Chair, Department of Radiation Oncology...

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...

Health Policy
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Joseph Bailes, MD

National Health Policy Expert...

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

Professor and Physician-in-Chief of the Ohios State Uni...

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

Professor and Director, Division of Hematology Oncology...

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...