Is Your Doctor on the Rituxan Retirement Plan?

In case you're unfamiliar, the Rituxan Retirement Plan (RRP) is an inside joke amongst oncologists. It's the kind of joke they make far out of patient's earshot. The joke- which I must warn you has no punch line and isn't funny - goes like this:

You're a doctor in a cancer treatment practice that not only sees patients but also administers chemotherapy. The arrival of the monoclonal antibody Rituxan (rituximab) in 1999 dramatically changed the outcome for many lymphoma patients, but it also changed your outcome as well because this biologic drug is A) effective and B) expensive. Since you administer the drug, you must first buy it from the manufacturer; then you are free to charge the insurance companies of your patients as much as five or ten times what you paid for it. Because Rituxan is not only a part of combination chemotherapy (in the likes of R-CHOP) but also, in many cases, given as consolidation or 'maintenance' therapy every eight weeks for two or more years following initial chemo, you're making so much money off the mark-up you put on Rituxan that you can joke with your colleagues about how the buying and selling of Rituxan is helping to pad your retirement.

I warned you it wouldn't be funny.

Rituxan Revenue

Rituxan generated in excess of $14 billion during its first decade on the market and has made more than $8 billion just in the years between 2009 and 2011. If there was any sort of billing consistency at all among doctors and hospitals this might be easier to look away from, but how much clinics and hospitals can charge for the Rituxan they buy from Genentech and then sell to patients is uncontrolled and extremely difficult to explain. The only consistency seems to be that it's making everyone involved in it very wealthy.

Fortunately it is also an effective anti-cancer medication, although it is plagued with a laundry list of side effects.

Conflicts of Interest

Doctors are constantly being tempted by this kind of profiteering--and failing miserably at withstanding it. The Rituxan Retirement Plan is really just the 'Chemotherapy Concessions' of a decade ago, where it came to light just how big a profit margin doctors were enjoying by administering chemotherapy, a profit margin that the then-head of the American Society of Clinical Oncology openly defended.

While nobody wants to refuse doctors their right to make a profit in their business, we should all be refusing them the ability to do so when doing so takes direct advantage of unknowing patients or even mildly inconveniences them.

Pharmaceutical companies used to make little secret of how they rewarded doctors who wrote lots of scripts for their drugs with lavish vacations and other payoffs. While no longer as blatant or obvious, don't be so naive as to think this is no longer going on. It is. The pharmaceutical industry lacks creativity and originality when it comes to creating new and effective drugs, but it knows how to generate sales as well or better than any other industry.

It has been reported elsewhere that in many cases doctors will routinely send their patients 20 or 30 miles out of their way to receive treatment at some far-flung facility that they could have received next door, except the doctor doesn't have a financial interest in the facility next door.

A pair of studies in the New England Journal of Medicine recently noted that the treatments recommended by urologists to prostate cancer patients had plenty to do with Medicare reimbursement and less to do with what was best for the patient.

Doctors in the limelight are no better. Everybody's favorite Oprah baby Dr. Oz is not only a quack but a wealthy one, thanks to his seeming willingness to say a good word about virtually any remedy that finds its way to his desk.

Remember when Dr. Drew Pinsky got busted for promoting Wellbutrin by GlaxoSmithKline without disclosing the fact that they had paid him $275,000? Sure, the money paid to him was above the board but his promotion of the drug-- without informing his audience of the payment-- is the ethical issue here, and no matter what his defense was, he can't get around the fact that he should have disclosed this relationship first, so that people can make up their own minds.

"Not my doctor."

That's the typical response from most patients. "Those crooks! But not my doctor." Cancer patients feel an affinity with their oncologist because he or she has their life in their hands. So they make frequent concessions for them. They apologize or defend their behavior. They exclude them from those otherwise unscrupulous doctors because they know their doctor, and he or she wouldn't do that.

Well they probably are doing that. Does it in any way interfere with the treatment you receive from them? It might be. And in many cases you won't know until you've already received treatment.