Cancer Blood Tests: More Expense, But Questionable Value
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The Financial Times reports (here) on blood tests for cancer, “Quick blood tests for cancer: a help or harm?” The report notes that “Investors are pouring billions into companies claiming they can analyse DNA to find the disease early. Some scientists question whether health systems need the extra burden — and if the technology works.”
“A pioneering group of people in the US and UK have elected to take part in a new form of cancer screening known as multi-cancer early detection tests (MCED). The tests use gene sequencing or other novel technologies to detect fragments of DNA expelled by cancerous cells that circulate in people’s blood, allowing the identification of multiple types of cancer from a single blood draw.”
The report notes “Health bodies in both nations have set up MCED clinical trials in the hope that the tests can be rolled out to the population at large; cancer is responsible for one in six deaths globally. The UK’s National Health Service is participating in a clinical trial of the Galleri test involving 140,000 patients. If the trial is successful, the NHS may buy 1mn units from Grail, the US company that developed GalGrail and an Indian company, Datar Cancer Genetics, [which] are already selling MCED tests to the public. Datar’s test is available in the UK with prices at various health clinics cited above £1,000. In the US, Galleri tests are sold as ‘laboratory-developed’ because they have not yet been approved by the US Food and Drug Administration.”
“At least a dozen rivals are also developing similar products for a sector that analysts forecast could expand from about $1.5bn in revenues this year to $23bn by 2031. In March, following intense lobbying by industry, US lawmakers introduced bipartisan legislation in Congress aimed at fast-tracking funding for the tests for people in US government health schemes such as Medicare.”
But there are critics. “‘It is a disgrace that companies are selling these tests without knowing what the benefits and the harms are,’ says Paul Pharoah, a professor of cancer epidemiology who works at Cedars Sinai. ‘False positives are a problem. False negatives are a problem. We don’t know how big those problems are, and we don’t know whether these tests make a meaningful difference to cancer mortality.’”
By way of context, the FT report notes that “Screening has been an important tool in the fight against cancer for more than half a century. It aims to reduce mortality or morbidity through early detection and treatment, for instance by identifying disease precursors such as patches of abnormal cells that can develop into cervical cancer or polyps that cause bowel cancer.”
“National screening programmes typically target a handful of common cancers, such as cervical, breast, bowel and lung, where there is evidence that early detection can improve outcomes for patients. Studies show that the rollout of pap tests, which detect abnormalities in cervical cells, is mainly responsible for a 75 per cent fall in the incidence and mortality of the disease in the US.”
More cancers, new screening: “At Grail’s headquarters in Menlo Park, California, executives hope to recreate this success for more than 50 different cancers for which there are no screening tests available. About three quarters of new cancer cases and deaths in the US are due to diseases without established screening programmes.”
Another caution, on money: “Susan Bewley, a consultant obstetrician and emeritus professor at King’s College London, says the problem with MCED screening is that the more of this you do on healthy people the more errors you get. ‘This sort of screening test could bankrupt the NHS, prioritise people who are well over those who are sick, and make people ill. This is ethically dubious,’ says Bewley. ‘Before these tests are rolled out we need to follow hundreds of thousands of people over many years to determine if the treatments actually stop them from dying.’”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Medical Schools’ Admissions Becoming More Economically “Elitist”
A Research Letter in JAMA (here) notes that “In 2009, the Liaison Committee on Medical Education introduced accreditation standards to increase medical student diversity. However, little is known about how socioeconomic status influences medical school applications and admissions. We examined trends in childhood household income among applicants and matriculants to medical school and the likelihood of acceptance by income.”
“Combining all years, the likelihood of acceptance into an MD program increased in a stepwise fashion by income. The adjusted rate of acceptance was 24.31% for applicants with income less than $50,000, 27.57% for $50,000-$74,999, 29.90% for $75,000-$124,999, 33.27% for $125,000-$199,999, and 36.91% for $200,000 or greater. All income groups were associated with a lower likelihood of acceptance than the highest income group. Applicants reporting income in the category of less than $50,000 were 48% less likely than applicants reporting income of $200,000 or greater to be accepted into an MD program.”
“Between 2014 and 2019, applicants and matriculants to MD programs increasingly came from households with higher childhood annual incomes, and, for all years combined, income was associated with an increased likelihood of medical school acceptance. Socioeconomic status may influence educational and experiential opportunities . . . and differences in the availability of these opportunities may be increasing over time.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
Torrent of Bills From the House
The Subcommittee on Health of the House Energy and Commerce Committee held a mark-up Wednesday, demonstrating a wide range of concerns, including:
the "Transparent Prices Required to Inform Consumer and Employers (PRICE) Act"; H.R.2666,
the "Medicaid VBPs (value-based purchasing) for Patients (MVP) Act"; H.R.3285,
the "Fairness for Patient Medications Act"; H.R.3284,
the "Providers and Payers COMPETE Act";
H.R.3290, to amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program;
H.R.2559, the "Drug Price Transparency in Medicaid Act of 2023";
H.R.2665, the "Supporting Safety Net Hospitals Act";
H.R.2679, the "Pharmacy Benefits Manager (PBM) Accountability Act";
H.R.3248, the "Diagnostic Lab Testing Transparency Act";
H.R.3262, to amend title XI of the Social Security Act to increase transparency of certain health-related ownership information; and
H.R.3282, the "Promoting Transparency and Healthy Competition in Medicare Act.”
DRUGS & DEVICES
Drug Shortages Near All Time High in U.S.
The New York Times reports (here) that “Thousands of patients are facing delays in getting treatments for cancer and other life-threatening diseases, with drug shortages in the United States approaching record levels.”
“Hospitals are scouring shelves for supplies of a drug that reverses lead poisoning and for a sterile fluid needed to stop the heart for bypass surgery. Some antibiotics are still scarce following the winter flu season when doctors and patients frantically chased medicines for ailments like strep throat. Even children’s Tylenol was hard to find.”
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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