Chemotherapy: profits vs. questionable benefits to patients

A story in the NYTimes today reports that oncologists are still trying to find ways to profit from treating their patients with expensive drugs, even though Medicare has cracked down on such profits two years ago (by limiting the markups docs can charge to 6% above the cost of the drug).

Doctors can get around the limitations in reimbursement by simply offering drugs to more patients, whether or not they'll benefit from them.

“There’s pretty good evidence at this point,” said Dr. Richard Deyo, professor of medicine at the University of Washington and an expert on health care spending, “that there are plenty of patients for whom there’s little hope, who are terminally ill, whom chemotherapy is not going to help, who get chemotherapy.”

Some doctors claim that the Medicare limitations are going to result in a lack of access to needed drugs for patients in rural areas, for example, although an unspecified federal commission cited by the article found this not to be the case.

In such a climate, how common are honest conversations between doctors and patients about the risks and benefits (not to mention the costs) of chemotherapy in terminally ill patients? I'd like to see studies on utilization of chemotherapy in settings where oncologists can't profit from use of the drugs (and I'm not sure where those are, given multiple payers, including Medicare, available in most care settings in the US), compared to those where they can. The extra-credit part would be comparing real health outcomes - not 5-year survival! - in different settings.