Tuesday, March 10, 2009

ARAY's hurdles

from the Yahoo MB:

>> 10-Mar-09 10:47 am

I appreciate yyy60's posts, as they illustrate some of the problems ARAY faces as well as opportunuties. The posts can be put in categories - pt pleas/testimonials, business-related, and opening of new centers.

As heart-rending and well-intentioned the pt stories can be, it is often evident even from the sparse clinical information given that CK either wasn't appropriate or was not the only option for a given pt's problem. A recent example was a stage 4 lung cancer where the pt received CK for brain mets but was upset it was not offered to lung tumors - it would be a rare situation where this would be appropriate. Another complained about CK not being offered for her mother's liver mets, though how effective this would be depends of the size and number of mets, the presence of other distant mets, the time from initial diagnosis, among other things. Take these stories with a shaker of salt and don't lose sleep over them.

The post I'm linked to illustrates a political problem for ARAY more complex than just rad oncs indirectly on Varian's payroll. The Univ of Louisville Med Ctr has a CK with an open staffing policy; med staff from competing hospitals could use the CK for their pts and bill for the professional component of the treatment, then bring the pt back to the original hospital for ongoing care. The competing hospitals, fearing loss of prestige or some ancillary services (eg planning scans), either enticed or threatened their doctors against using the CK for their pts. Similarly, my hospital paid for several outside surgeons to be credentialed by ARAY, and gave them limited privileges to use the CK. While they were initially interested, we have not had a single referral from them, even from hospitals within our system. One admitted her hospital's administrators frowned upon sending pts to us for CK.

It is crap like this, not to mention rad oncs owning LINACs, CPT code roadblocks set-up by Varian, the financial crisis and current healthcare climate/uncertainties, that make me think the recognition of CK as a true breakthrough will come, ironically, from outside the US. yyy60's posts on Asian centers are encouraging. Prevalent diseases in Asia such as hepatocellular and nasopharyngeal cancers (and of course lung cancer) are particularly suited for CK. Compared to other cancer therapies, one need not be an Arab shiek or Taiwanese tycoon to afford CK. It is well within range of at least the Indian or Japanese upper middle classes, and it will be clinical results that count. As I have felt since ARAY's stock price plummeted, any recovery if it is to occur will not come because of new suits on the BOD, restructuring, videos, or PR (as important as those things are in any company), but because of clinical results, and this will be a long, long haul.

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