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DR PAUL RICHARDSON:
DOES A CANCER PATIENT HAVE TO WORRY
ABOUT HOSPITAL CORRUPTION AS WELL?

by Semmel Weis
First published 31Dec2017  Last edited 15Sep2018  01:33am

Let us imagine a cancer sufferer, trying to find the cancer clinic likely to give him the best treatment, and who comes across the U.S.News & WORLD REPORT (USNews) ranking of 50 adult-cancer hospitals, and takes a particular interest in the top ten.  However, of the USNews top ten adult cancer centers, he is unable to find OpenPayments data for the following five (click USNews logo to access original data; however, it was noted on 15Sep2018 that the USNews rankings had shifted a bit, as is to be expected with the passage of almost nine months):

U.S.News & World Report logo
#1 
adult cancer hospital

Best Hospitals ranking by US News
#2 
adult cancer hospital

Best Hospitals ranking by US News
#5 
adult cancer hospital

Best Hospitals ranking by US News
#6 
adult cancer hospital

Best Hospitals ranking by US News
#9 
adult cancer hospital

Best Hospitals ranking by US News

MD Anderson logo

Memorial Sloan Kettering logo


Seattle Cancer Care Alliance logo
Johns Hopkins Hospital logo Moffit Cancer Center logo
University of Texas
MD Anderson Cancer Center
Houston, TX 77030-4000
Memorial Sloan Kettering
Cancer Center

New York, NY 10065-6007
Seattle Cancer Alliance/University of Washington Medical Center
Seattle, WA 98109-4405
Johns Hopkins Hospital


Baltimore, MD 21205-1832
Moffitt Cancer Center and Research Institute

Tampa, FL 33612-9497
Big Pharma disclosure of payments to MD Anderson Cancer Center ?

Big Pharma disclosure of payments to Memorial Sloane Kettering ?

Big Pharma disclosure of payments to Seattle Cancer Alliance ?

Big Pharma disclosure of payments to Johns Hopkins Hospital ?

Big Pharma disclosure of payments to MOFFITT CANCER CENTER ?


Next we consider Pharma payments to the five adult-cancer hospitals that are reported by OpenPayments.  Although USNews considers the Mayo Clinic as a single entity ranking #3, and Dana-Farber as a single entity ranking #4, OpenPayments breaks each into two pieces:

Mayo Clinic logo Dana-Farber/Brigham Women's Cancer Center

#3 
adult cancer hospital

Best Hospitals ranking by US News
#4 
adult cancer hospital

Best Hospitals ranking by US News
Mayo Clinic, Saint Marys Campus Mayo Clinic Methodist Hospital Dana-Farber Cancer Institute    Brigham and Women's Hospital
MAYO CLINIC
SAINT MARYS HOSPITAL
1216 Second Street SW
Rochester, MN 55905
MAYO CLINIC
METHODIST HOSPITAL
201 West Center Street
Rochester, MN 55902
DANA-FARBER
CANCER INSTITUTE
450 Brookline Ave
Boston, MA 02215
BRIGHAM AND WOMENS
HOSPITAL
75 Francis Street
Boston, MA 02115
2016
General Pay     $1,116,664
Research Pay   $4,100,396
2016
General Pay     $191,654
Research Pay   $161,962
2016
General Pay       $3,727,295
Research Pay   $49,153,159
2016
General Pay     $11,463,017
Research Pay   $29,266,003
2015
General Pay     $474,454
Research Pay   $144,277
2015
General Pay     $591,131
Research Pay   $219,571
2015
General Pay       $3,549,399
Research Pay    $34,714,274
2015
General Pay     $11,721,964
Research Pay   $47,194,642
2014
General Pay     $462,412
Research Pay   $107,835
2014
General Pay     $352,607
Research Pay   $115,313
2014
General Pay       $4,936,882
Research Pay   $43,373,464
2014
General Pay     $11,374,588
Research Pay   $67,632,650
2013 (Aug-Dec)
General Pay       $18,353
Research Pay   $302,822
2013 (Aug-Dec)
General Pay     $579,646
Research Pay   $176,758
2013 (Aug-Dec)
General Pay       $1,148,818
Research Pay   $14,262,452
2013 (Aug-Dec)
General Pay       $1,578,752
Research Pay   $17,872,310
Big Pharma disclosure of payments to Mayo Clinic Saint Marys Hospital $6,727,213
openpaymentsdata.cms.gov
Big Pharma disclosure of payments to Mayo Clinic Methodist Hospital $2,388,642
openpaymentsdata.cms.gov
Big Pharma disclosure of payments to Dana-Farber Cancer Institute $154,865,743
openpaymentsdata.cms.gov
Big Pharma disclosure of payments to Briham and Womens Hospital $198,103,926
openpaymentsdata.cms.gov
Disclosure of Big Pharma payments to Mayo Clinic
over the MAYO CLINIC has a strength of

$9,115,855

Disclosure of Big Pharma payments to Dana-Farber
over DANA-FARBER/BRIGHAM has a strength of

$352,969,669


As Cleveland and Penn seemed to be tied, USNews obliged them to share the #7 spot:

#7 
adult cancer hospital

Best Hospitals ranking by US News
#7 
adult cancer hospital

Best Hospitals ranking by US News
#10 
adult cancer hospital

Best Hospitals ranking by US News
Cleveland Clinic Hospital logo

Penn Presbyterian Medical Center logo


UCSF Medical Center logo
CLEVELAND CLINIC HOSPITAL
9500 Euclid Avenue
Cleveland, OH 44195
PENN PRESBYTERIAN MEDICAL CENTER
39th & Market Streets
Philadelphia, PA 19104
UCSF MEDICAL CENTER
505 Parnassus
San Francisco, CA 94143
2016
General Pay     $10,232,247
Research Pay   $30,397,080
2016
General Pay     $75,457
Research Pay   $61,127
2016
General Pay        $871,782
Research Pay   $1,514,792
2015
General Pay     $16,645,641
Research Pay   $35,634,070
2015
General Pay     $68,914
Research Pay   $16,200
2015
General Pay        $934,633
Research Pay   $1,685,659
2014
General Pay     $13,177,045
Research Pay   $28,620,190
2014
General Pay     $59,877
Research Pay   $73,168
2014
General Pay     $1,195,282
Research Pay   $8,905,041
2013 (Aug-Dec)
General Pay       $9,174,019
Research Pay   $13,913,816
2013 (Aug-Dec)
General Pay        $199
Research Pay   $1,000
2013 (Aug-Dec)
General Pay       $769,690
Research Pay   $1,572,141
Big Pharma disclosure of payments to CLEVELAND CLINIC HOSPITAL over the CLEVELAND CLINIC has a strength of

$157,794,108
openpaymentsdata.cms.gov
Big Pharma disclosure of payments to PENN PRESBYTERIAN MEDICAL CENTER over PENN PRESBYTERIAN has a strength of

$355,942
openpaymentsdata.cms.gov
Big Pharma disclosure of payments to UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER over USCF MEDICAL has a strength of

$17,449,020
openpaymentsdata.cms.gov

Perhaps the first question that the above payments invite is — why do five out of the top ten hospitals make no appearance in OpenPayments?  Perhaps their OpenPayments entries were too small to qualify for being even mentioned?

But with the example of Dana-Farber receiving $353 million over three-years-five-months, why wouldn't MD Anderson and Sloan Kettering, and so on, have dipped their hands into that same very deep Big-Pharma purse as well?  One possible answer might be that MD Anderson and Sloan Kettering, and so on, regarded patient welfare as their highest goal, and realized that acceptance of Pharma cash would compromise that goal, which in the near term would result in reliance on therapies which optimized Pharma profits rather than patient well-being, and which in the long term would result in needless suffering and premature death.

Why does Dana-Farber rake in 39 times the pharma payments of Mayo?  What is the essential difference between Dana-Farber and Penn Presbyterian that causes Big Pharma to pay them in the ratio of 992:1?

I put these questions to you particularly, Dr Richardson, because you seem to be in a position to know best how to answer them, given that your three-year-five-month involvement in Pharma-Power payments totalling $19.6 million may be record-holding for an individual doctor, and given that you are affiliated with Dana-Farber whose three-year-five-month acceptance of the OpenPayments total of $353 million may be record-holding for a cancer clinic.  Do you not agree that there is something broken in the drug industry, and that repair is impeded by a high level of secrecy which leaves the public able to no more than sift through fragmentary data and speculate as to what's going on behind the curtain?

And pity the patients!  They typically walk into a cancer clinic unaware that hundreds of millions of Big Pharma dollars may be flowing into its coffers, and in that clinic they typically confer with a doctor while also unaware that tens of millions of Big Pharma dollars may be passing through his hands.

The rule specifying what disclosure is owed these patients has already been set, as for example by The International Council for Harmonisation-Good Clinical Practice (ICH-GCP), where I take the rule applying to subjects in clinical trials to extend also to patients contemplating therapy or already in therapy — that what is obligatory to disclose is any information which might alter the patient's willingness to participate.  The Big Pharma payments involving individual doctors, or delivered to hospitals, certainly might alter such willingness, and therefore must be disclosed, up front and in large print — wouldn't you agree?

International Council For Harmonization-Good Clinical Practice logo
ICH.ORG    [red empahsis added]

1.28  Informed Consent

A process by which a subject voluntarily confirms his or her willingness to participate in a particular trial, after having been informed of all aspects of the trial that are relevant to the subject's decision to participate.  [...]

4.8.2  The written informed consent form and any other written information to be provided to subjects should be revised whenever important new information becomes available that may be relevant to the subject’s consent.  [...]  The subject or the subject’s legally acceptable representative should be informed in a timely manner if new information becomes available that may be relevant to the subject’s willingness to continue participation in the trial.  [...]

4.8.7  Before informed consent may be obtained, the investigator, or a person designated by the investigator, should provide the subject or the subject's legally acceptable representative ample time and opportunity to inquire about details of the trial and to decide whether or not to participate in the trial.  All questions about the trial should be answered to the satisfaction of the subject or the subject's legally acceptable representative.  [...]

4.8.10  Both the informed consent discussion and the written informed consent form and any other written information to be provided to subjects should include explanations of the following:  [...]

(p) That the subject or the subject's legally acceptable representative will be informed in a timely manner if information becomes available that may be relevant to the subject's willingness to continue participation in the trial.



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