There was a time when doctors treated patients based on the best information, personal experience and most importantly an overarching desire to save the life. As medicine has become more corporatized and reimbursement has risen to the fore, the regulatory environment now dissuades physicians from diverging from rigid treatment guidelines.
We are witness to the rise of "robotic" medicine, featured most prominently in oncology.
(Not to be confused with robot-assisted surgery, robotic medicine is the antithesis of empathetic care and reflects the worst in human indifference to pain and suffering.)
Based on reimbursement and guidelines, most doctors will not vary their treatment recommendations whatsoever. This became glaringly evident in three recent cases.
The first is a woman with recurrent breast cancer whose tumor had metastasized to the ovary. Failing first and second line therapy, treatment choice had devolved into a guessing game. As she was scheduled for ovarian surgery, she asked if we could process her tissue. The surgeon was in agreement but the pathologist proclaimed that he would not process the sample. As we are a CLIA licensed laboratory, registered with the federal and state governments to conduct these studies the pathologist stance was indefensible yet he was adamant and the sample was not submitted.
I have come to learn that the hospital has now changed their policy but this is too little, too late for this unfortunate young woman. As a result of the pathologist's refusal, we are now forced to schedule a new biopsy to conduct the study that should have been done at the time of her surgery.
Multiple Recurrent Sarcoma
The second is a young man with multiply recurrent sarcoma. His pediatric oncologist was in agreement with our conducting the study and the analysis identified a particularly active combination of two FDA approved drugs, widely used in other cancers. Although the combination is well-established in the adult literature, it is not well known in the pediatric literature.
In support of our recommendations I forwarded our peer-reviewed, published clinical trial and provided our treatment protocol. Yet, it remains to be seen whether the physician will follow these simple recommendations.
Heavily Pre-Treated Recurrent Sarcoma
The third example is a heavily pre-treated young woman in Chicago with recurrent sarcoma. We identified an active combination yet the physicians are utterly unwilling to consider it. I reached out to my pediatric oncology colleagues in the fibrolamellar program at Rush in Chicago (right down the street), but they too were unsuccessful in convincing the physicians; this despite our remarkable results in fibrolamellar cancer, another rare pediatric cancer, reported at ASCO in 2023 (Ajay, OG et al Proc ASCO Abs #4103, 2023).
Each of these examples represents a physician taking a stance that is contrary to the best interests and well-being of their patient. Driven by regulatory oversight, reimbursement, personal bias and yes, likely ego, these doctors failed to fulfill their Hippocratic Oath. It was their duty to perform their best service for their patient within the law.
It is particularly frustrating for our laboratory to identify active treatments for patients and then see them go unused. We conduct these analyses to save lives. Physicians who choose not to use our findings are doing their patients a disservice.
It is increasingly important for patients to find physicians who take their patients’ best interest to heart. Anything less is a breach of their Hippocratic Oath.