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Newsletter Archive Index Vol. 6, No. 1 January 2002 Editor: Pamela B. Colker, Esq. THE SIXTH ANNUAL ELLEN P. HERMANSON MEMORIAL SYMPOSIUM The Sixth Annual Ellen P. Hermanson Memorial Symposium was held on November 7, 2001, at Saint Vincent’s Medical Center in Manhattan. The panel of medical and legal experts gathered to discuss the rationing of medical care, and the impact of managed care and reimbursement policies on cancer detection and access to cutting-edge treatments. The evening began with an update by Dr. Larry Norton of the latest developments on the forefront of cancer research and treatment. He spoke of the excitement around anti-angiogenisis drugs, produced to kill the blood vessels that feed cancer cells. Dr. Norton described ductal lavage, a new method for the assessment of cell function and the detection of any cell abnormalities in the breast. This technique introduces fine tubes into the nipple, in a virtually painless process, whereby fluid is introduced and drawn out in order to examine captured cells for the presence of cancer. Additionally, Dr. Norton described new discoveries in the treatment of some rare diseases, which have led to the development of drugs designed to interfere with a triggering abnormality. Dr. Norton spoke of the promise of a new drug, SDI 571, so named Gleevic. He described that in the treatment of a rare chronic myologenous leukemia, it was discovered that Gleevic could be administered to block the initiating event which triggers the translocation of a chromosome (breaking off from its original location, the chromosome attaches to a foreign location, forming an abnormal fusion of protein). In disabling the function of the fusion protein, Gleevic has been shown to kill the leukemia cell. The staggering implication of this discovery, Dr. Norton maintained, is the very real possibility that cancer can be cured with drugs. If we can find the driving abnormality and block it with a molecule, he explained, we can then kill it with a drug. Hon. Helen E. Freedman raised the question of just how much access all members of our population have to both widely used and cutting-edge treatments. It should be noted that a screening technique common to many of us - mammography - is not accessible to everyone in the United States, due to economic, geographic and training issues. Dr. Annette Brown emphasized, however, that the ductal lavage method of evaluation is not a screening device but rather a procedure reserved for targeted evaluation in a high-risk patient. She also explained the expense of technology (including the use of mammography machines) on the practitioner’s side of the equation. Fees paid to offices from managed care and other programs, she stated, do not meet the costs of the maintenance and operation of technological equipment. It has been reported that during the last year several mammography centers have been closed in Manhattan, mainly due to low reimbursement rates. While radiologists have claimed that the rate of reimbursements from managed care and Medicare programs do not cover the costs expended to provide service and maintain equipment, managed care companies argue that the reimbursement rates are appropriate and that the problems stem from a lack of efficiency among providers. In October 2000, The Wall Street Journal reported that many women were experiencing difficulty obtaining mammograms. This is a disturbing consideration, in light of the efficacy of this tool in detecting many covert cancers and the role mammography has apparently played in saving women’s lives. Eva Talel contended that managed care is only part of the problem when it comes to coverage, adding that many people have no coverage at all (the availability issue, therefore, goes well beyond the managed care reimbursement rate). She noted that employers cover most insurance in the United States, and that the ability of most employers to provide insurance is related to the climate or cost of coverage. Ms. Talel observed that as a society it is clear that some rationing of healthcare is endorsed and that the question now becomes, “what is to be rationed and who will decide and by what process?” As this relates to breast cancer screening and treatment, it highlights the problem of accessibility, particularly for those without coverage of any kind. Patty Delaney noted the disturbing disparity she has encountered in her experience, wherein the better educated and wealthier the individual, the more likely they will find the service they seek, while others are left out of the mix. As far as the cutting-edge treatments offered in clinical trials, pharmaceutical companies can exercise great power in choosing which drugs are to be studied within the constraints of the Institutional Review Boards. In addition, those patients who seek the new treatment must submit to the process of randomization and can only hope to receive the drug being tested (unless they can be assured access under the “compassionate care” protocol endorsed by the Food and Drug Administration). (Clinical trials provide either the treatment believed to be the standard of care or the new treatment being tested.) New York’s External Review Law, enacted in July, 1999, provides an avenue for those who have been denied coverage due to a finding by an HMO that a recommended treatment is not “medically necessary.” This measure, whereby the external agent examines whether reviewers correctly determined if the proposed treatment is likely to be more beneficial than any standard treatment or, in the case of clinical trials, if such trial is, “likely to benefit the enrollee,” provides patients with a tool to fight for coverage in and outside clinical trials. Once again, this year the panel brought critical issues to the forefront, and provided thought-provoking discussion. The JALBCA Symposium was attended by members of the legal and medical communities, friends from Gilda’s Club and the community at large. It was a most candid and invigorating evening. We at JALBCA express our gratitude to Weitz & Luxemberg, for generously underwriting the Courthouse Alert mammogram vans this year. OCTOBER COURTHOUSE ALERT Throughout the state each year the Courthouse Alert provides educational material on breast cancer detection and treatment. Each October JALBCA, working with the Women’s Bar Association of the State of New York, arranges for educational programs and for the distribution of breast cancer literature throughout New York courthouses. In the New York City area, mobile mammography vans, provided by the American-Italian Cancer Foundation, are also located at various courthouses throughout New York City, to make free mammography services available (this year, due to disruptions in downtown Manhattan, arrival of the mammography van was delayed until November). On Friday, October 19, 2001, JALBCA, Hon. Helen Freedman’s courtroom was the site of an interactive workshop on breast health, courtesy of the American Cancer Society (“ACS”). Susan Solomon, Secretary of JALBCA and the New York County Coordinator of the Courthouse Alert, orchestrated a successful and lively informational morning. At 9:15am counsel’s table yielded a generous buffet of breakfast spreads for a steady stream of attendees including courtroom personnel, attorneys, and visitors. An informational video of an actual mammography exam provided the backdrop for a step-by-step demonstration of a breast self-examination, given by Maria Elena Maza, ACS Volunteer in the Breast Health Services Division. A question and answer period followed, with breakout tables for more specific one-to-one questions with Cecelia Dunhy, a former RN and ACS “Reach-to-Recovery” program (a “buddy-system type of pairing of patient to survivor) volunteer. On November 19th, mammography vans arrived at a visible location opposite 111 Centre Street. They were utilized to full capacity, with 59 mammography appointments scheduled (20 more than could be accommodated), an indication of how vital this service has become to the New York City community and beyond. BULLETIN BOARD Join us after the next JALBCA meeting of the Board of Directors, on February 6, 2002, with Dr. Anne Moore, as she discusses a new class of breast cancer drugs known as aromatase inhibitors appear to extend survival more than the standard tamoxifen, according to reports on the latest research. |
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