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ASCO’s Value Framework Abandons the Hippocratic Oath

VBCC - July 2015, Vol 6, No 6 - VBCC Perspectives
Robert Goldberg, PhD
President and Co-Founder
Center for Medicine in the Public Interest
Springfield, NJ

The American Society of Clinical Oncology (ASCO) new value framework abandons the Hippocratic Oath. No longer is the doctor’s first obligation to “apply, for the benefit of the sick, all measures which are required.” Instead, ASCO’s value framework has the potential to help insurers “evaluate the relative value of new treatments” as they develop “benefit structures, adjustment of insurance premiums, and implementation of clinical pathways and administrative controls.”1

Despite claims that the value framework makes patient preferences paramount, patients with cancer “overestimate the benefits of treatments that sometimes extend life by only weeks or months or not at all.”1 ASCO’s Value Task Force Co-Chair Lowell E. Schnipper, MD, Chief, Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, wrote elsewhere that 3 months of added life “is not a large enough benefit to trump the greater benefits to many that would have to be foregone to provide it.”2 That’s rationing.

The ASCO Value Task Force declares that increasing overall survival by <20% is worthless. That cutoff would eliminate paying for treatments for pancreatic, brain, lung, and stomach cancers in use or being studied today. By way of comparison, the life expectancy of patients with AIDS increased <20% annually between 1987 and 2000. The ASCO new value framework would have denied life to thousands of people who are alive today.

The framework stacks the deck further by measuring averages from randomized trials and ignoring the genetic variation in patient response that “targeted” cancer drugs address.

The Value Task Force tacitly endorses benefit designs that restrict the use of new medicines, including the shifting of drugs to the highest cost-sharing tier and fail-first pathways. Meanwhile, the Obama ad­­ministration warns that “placing most or all drugs that treat a specific condition on the highest cost tiers…discourage[s] enrollment by individuals based on age or based on health conditions, in effect [is] mak­­ing those plan designs discriminatory.”3

Not only does the ASCO Framework from the Value Task Force enable this bias, but it will also cost thousands of lives.




References

  1. Schnipper LE, Davidson NE, Wollins DS, et al. American Society of Clinical Oncology statement: a conceptual framework to assess the value of cancer treatment options. J Clin Oncol. 2015 Jun 22. Epub ahead of print.
  2. Schnipper LE, Meropol NJ, Brock DW. Value and cancer care: toward an equitable future. Clin Cancer Res. 2010;16:6004-6008.
  3. Centers for Medicare & Medicaid Services (CMS), HHS. Patient Protection and Affordable Care Act; HHS notice of benefit and payment parameters for 2016. Final rule. Fed Regist. 2015;80:10749-10877.
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Last modified: July 24, 2015
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