|
||||||||||||||
|
Vol. 9, No. 1 · February 2005 · Editor: Martha L. Golar, Esq.
· Ninth Annual Ellen P. Hermanson Memorial Symposium · Recent News Announcements · Harlem Mammography Van · Calendar of Events Upcoming JALBCA 2005 Programs -- Preliminary Calendar March 1, 2005, 6:30 - 7:30 PM “The Medicare Modernization Act and its Impact on the Quality of Cancer Care” SPEAKER: Joseph S. Bailes, M.D. a past President of American Society of Clinical Oncology LOCATION: Skadden Arps Slate Meagher & Flom, 4 Times Square (42nd & Broadway) March 15, 2005, 6:30 - 7:30 PM Co-sponsored with SHARE, “Clinical Trials 101: How do we know that cancer treatments work? Which trials are better than others?” LOCATION: Skadden Arps Slate Meagher & Flom, 4 Times Square (42nd & Broadway) SPEAKER: Musa Mayer, breast cancer advocate and FDA Patient Representative Ninth Annual Ellen P. Hermanson Memorial Symposium By Ada Chiu On October 4, 2004, JALBCA held its Ninth Annual Ellen P. Hermanson Memorial Symposium at the Association of the Bar of the City of New York. It was a lively and informative discussion that captivated the audience by touching on hot topics such as medical malpractice, health care financing and regulations. The Hon. Judith Kaye moderated the panel, which consisted of Hon. Helen E. Freedman, Hon. Shirley W. Kornreich, Hon. Sondra Miller, and Hon. William C. Thompson. The panel of experts included Judith Livingston, a partner at Kramer Dillof Livingston & Moore, a plaintiffs’ personal injury firm; Robert S. Melnick, a partner at Aaronson Rappaport Feinstein & Deutsch, a medical malpractice defense firm; Minna Elias, the New York Chief of Staff for Congresswoman Carolyn Maloney; and Dr. Larry Norton, the head of the Division of Solid Tumor Oncology at Memorial Sloan-Kettering Cancer Center.  Judge Kaye opened the program by acknowledging the important contribution made by, and inspiration of, JALBCA’s first Executive Director, Ellen P. Hermanson. She also noted that the CLE sponsor for the Symposium was the Women’s Bar Association of the State of New York. Special mention was made of JALBCA’s beloved Secretary and founding member, Susan Solomon. Dr. Norton began his presentation with an update on the latest drugs and technology being used to fight breast cancer. Some examples were Tamoxifen, which has reduced breast cancer by as much as 50%, although it slightly increases the risk of endometrial cancer, a more easily treatable disease. Dr. Norton also mentioned aromatase inhibitors, a group of drugs which help block the conversion of testosterone into estrogen in post-menopausal women. They reportedly reduce the incidence of breast cancer by 80%. Dr. Norton explained that cancer is not caused by genes going crazy. Rather, he told the audience to think of an automobile which is dangerous if it speeds up and moves too quickly. The cancer cell is actually a cell functioning faster than a normal cell. It is driven by precise abnormalities, and Dr. Norton contended that if the abnormalities can be identified through breakthroughs in molecular biology, the promise of a cure is close at hand.  Dr. Norton stated, “the issue is providing women not only with technology that exists today, but the technology of tomorrow. The answer is no longer in science -- the tools are already there. We need to address how to get the job done faster and the advances out to the community.” He mentioned advances in interventional radiology as the direction for the future in breast cancer treatment, such as MR Spectroscopy and PET scans which can catch cancers when they are absolutely microscopic, and con-focal ultrasound, which is being used to destroy microscopic cancer cells.Judge Kaye asked, “When a mammographer reads a mammogram, are there a lot of false negatives?” Dr. Norton responded, “[T]here are about 15% false negatives. It’s actually the fear of making a mistake, not the liability. Most of the cases alleging misread mammograms are valid, either because of poor-quality mammograms or a poor-quality mammographer. I would like to see mistakes not being made.” When asked about the litigation issue as a barrier to care, Ms. Livingston replied, “[I]t’s too easy to blame litigation” and stated she was glad Dr. Norton noted that most of the lawsuits that are initiated are for good reason. When asked for his view on the medical malpractice situation as a well-known defense attorney, Mr. Melnick responded that his information, which was obtained purely by speaking with numerous radiologists, is that “there is paranoia from radiologists, partly from mammographers, that they have a liability crisis. They feel someone is always watching over their shoulder.” Dr. Norton disagreed that the radiologists were "paranoid" about lawsuits, stating that in his experience, the threat of suits was a big part of why mammographers leave the field. Mr. Melnick suggested “there are ways to improve the quality of mammographic reading outside the tort system. One [way] is to make the field financially feasible for the radiologist to remain doing mammographies. The current reimbursements are so low that the radiologists give up doing mammographies and switch to reading CT or MRI scans, which pay more.” Quoting statistics from a 2003 press release by the American College of Physicians, Judge Kornreich reported that “more than 700 mammography sites have closed over the last 2 years, that is 7% of sites in the country.” She cited a 2002 press release from Anthony Weiner, which reported that the waiting time for a mammogram appointment in New York City was approximately 6.1 weeks, and in Florida, over three months, reporting the reasons for the delay as "high liability" and "low reimbursement." Judge Kornreich also cited a 2003 press release from Rep. Charles Schumer which reported that the cost of performing a mammogram in New York City was approximately $120-$140, but the reimbursement was only $81, and asked whether something was being done from a legislative standpoint to improve this situation. Ms. Elias responded by agreeing that, while reimbursements were still below cost, in NYC reimbursements have increased to about $104-$105, and that there was legislation pending in Congress to increase reimbursement, but it was not moving.  The panel focused on an important issue. As health care operating costs and staff salaries continue to rise, already below-cost, stagnant mammogram reimbursements will only further the financial losses of performing these exams. Judge Freedman then asked Dr. Norton, “Assuming reimbursement rates will not increase in a significant way, and assuming the number of breast cancer specialists continues to decline, are there any new viable alternatives such as using non-physicians for the first level of screening or outsourcing?” Dr. Norton replied that although Judge Freedman’s idea was good, because of liability, the work would still fall on the physicians to double-check and sign off that the non-physicians correctly read the mammogram, so in essence, a mammographer would still have the same amount of work.Judge Thompson asked Dr. Norton about a recent article in the New York Times, claiming "the majority of radiologists are not doing a good job." Dr. Norton responded that there was a large need for more specialists, citing the existence of only 4,000 in the U.S. who specialize in breast imaging, with the rest of the mammograms being read by other general radiologists. He advised, “high-risk patients should have both mammograms and a breast MRI every six months. However, this would cost more money, it’s harder to do and there are fewer people trained to do it. So people are using sonograms in private practice, but sonography is not yet where it really needs to be. The problem with MRI is that there are very few doctors in the United States who can really read breast MRIs.” Ms. Elias stated she saw the issue as “not whether there are good or bad people reading, but that there are not enough people reading [mammograms].” Dr. Norton agreed, stating that “the need is growing but the supply is shrinking, so the ‘need-and-supply’ theory is out of whack.” He further warned that, “if the current trend continues, people who can afford to go to big academic centers will get stupendous care, and everyone else gets not terrible, but a lower level of adequate care.” Dr. Norton suggested an idea that he said was already in place in Europe: “Every country in Europe has a national mammography program -- why don’t we have it here? 50% of all cancers would be diagnosable if there was adequate screening.” Judge Freedman responded by saying, “Other countries don’t have optimum systems either. In Great Britain, they only notify women every three years.” While Dr. Norton further stated that England has the highest death rates from cancer, he also stated [the high death rate] was mostly due to a failure to refer after a diagnosis has been made. There is no one thing -- it is a confluence of factors which all contribute to the barrier to access of quality care. Dr. Norton concluded his remarks by urging, “social, economic and legal forces must come together to make this work,” referring to breast cancer. Recent News Announcements Jaw Ailments of Cancer Patients Reportedly Linked to Aredia The Wall Street Journal reported on December 8, 2004, that certain oral surgeons have come to believe that two Novartis drugs, which are used to stop cancer cells from dissolving bone, result in problems in the jaws of some patients because they, in fact, interfere with the bone-dissolving process. New cells do not grow unless the old ones are killed off, so that bone does not heal following dental work and is more prone to infections. Dr. Ruggiero, chief of oral and maxillofacial surgery at the Long Island Jewish Medical Center, identified Novartis’s Aredia in connection with patients suffering from osteonecrosis of the jaws, or jawbone death. Dr. Ruggiero claimed to have reported his cases on MedWatch, the Food and Drug Administration's computer system for tracking dangerous side effects from drugs, and he has since gathered information on many other cases in which patients taking Aredia, and Novartis’s successor drug Zometa, have experienced such problems. The pharmaceutical company noted the possible side effect on the package inserts for these drugs as of 2003. Novartis says that some oncologists are skeptical about a link between the osteonecrosis cases and the drugs although its drug salespeople are giving pamphlets to doctors warning of the possible risk. The WSJ article also cited that a patient advocacy group, the International Myeloma Foundation, surveyed 1,203 myeloma and breast-cancer patients and found 75 reporting a diagnosis of osteonecrosis of the jaw, with an additional 77 having reported symptoms including exposed bone and bone spurs. The advocacy group presented the results of its survey at an American Society of Hematology in December 7, 2004. Arimidex May Be More Effective Than Tamoxifen for Older Patients In December 2004, the results of a five-year study involving Arimidex (known by the generic name anastrozole) were reported. They constitute the most definitive finding to date that this drug improved disease-free survival over Tamoxifen. Reportedly, Arimidex might be able to prevent 70 to 80 percent of the most common type of tumors that occur in women after menopause, compared to the 50 percent that Tamoxifen is credited with preventing. While the results do not meet the toughest standard when evaluating a drug’s value, i.e., improving overall survival, researchers believe it clearly beats the standard treatment, Tamoxifen, which has been used for more than 20 years. The study involved almost 2,000 American women and an additional 7,300 from 20 other countries. The U.S. portion of the study was headed by Dr. Aman Buzdar, a specialist at the University of Texas’s M.D. Anderson Cancer Center. Arimidex, which is one of a new class of breast cancer drugs, aromatase inhibitors, has certain benefits besides a survival advantage -- fewer cases of endometrial cancer, blood clots, hot flashes and vaginal bleeding and discharge than among Tamoxifen users. Users of the drug, however, experience more joint pain and bone fractures. Harlem Mammography Van Mary Jenkins, Lucy Viana and Kay Murray spent all morning at the Harlem courthouse in October observing the mammography van activities and chatting with the van staff. Handouts were distributed in English and Spanish and 41 appointments were scheduled. In the end, more than twenty women obtained mammographies at the Harlem site. A special thank-you is in order for Justice Silbermann, who arranged for the cooperation of the Association of Secretaries to Supreme Court Justices (New York County Chapter) in connection with the event. In addition, our thanks to Judge Martino for his cooperation, to the Association of Secretaries to Supreme Court Justices, and, of course, to Kay Murray for all of her hard work.  Calendar of Events SHARE (SELF-HELP FOR WOMEN WITH BREAST OR OVARIAN CANCER) 1501 Broadway, Suite 704A NY, NY 10036 www.sharecancersupport.org 212.719.0364 SHARE HOTLINE: Breast: 212.382.2111 Ovarian: 212.719.1204 MEMORIAL SLOAN-KETTERING POST-TREATMENT RESOURCE PROGRAM Post-Treatment Resource Program Educational Forums 1275 York Avenue, Room M107 NY, NY 10021 www.mskcc.org 212.717.3527
ADELPHI NY STATEWIDE BREAST CANCER HOTLINE & SUPPORT PROGRAM Adelphi University School of Social Work Garden City, NY 11530 800.877.8077 JALBCA does not endorse the content or efficacy of any workshops or programs listed in the Calendar of Events; listings are for informational purposes only, so that our readership is aware of current offerings. |
|||||||||||||
|
||||||||||||||
Home | About | Hotline | Newsletter | Calendar | Contact Mailing List | Membership | Donations | Links |
||||||||||||||
|