Weighing the Value of Medicine

John Marshall, M.D., sometimes surveys his oncology colleagues around the country on which cancer drugs they would swipe their own credit card for, trying to get a sense of which therapies they think would be worth their own money if they had to pay out of pocket.

John Marshall, M.D.


The list is always remarkably short. When it comes down to it, people want value, and many cancer drugs are prohibitively expensive when looked at through this lens.

"Value has become very important to us in medicine today," says Marshall, head of hematology/oncology at Georgetown Lombardi Comprehensive Cancer Center, a part of Georgetown University Medical Center and Georgetown University Hospital. "How do we define the value of treatments we are giving to patients? How do drugs stack up against one another from a value perspective and what do patients want?"


Hard Questions to Address

The answers to these questions are not simple— nor are they without controversy. But Marshall says the conversation is an important one to have, and is long overdue. He cites bodies around the world—England’s National Institute for Health and Clinical Excellence (NICE), for example, have long been assigning value to medical care.

The U.S. is just starting to engage in similar discussions in light of the ongoing political debate over health care reform and the timely matter of reducing the national budget shortfall.

Yet politicians can’t be the only ones at the table, Marshall asserts.

“We need to give our regulators some targets to define value. They need to include those of us who practice medicine in the discussion, and they will need to include patients in the discussion of what’s worth it, that is, what should we be spending our tax dollars on and what shouldn’t we be?” Marshall says.

The United States must begin to craft its own coherent set of policies based on an inclusive and vigorous dialogue, he says.

Dr. Marshall notes that this is a time of change but also a moment of opportunity. He adds, “Through a careful reexamination of our current cancer research and treatment community, we will find a smarter, more efficient more promising path forward.”

The Ruesch Symposium is a catalyst for gaining a global prospective on cancer care. For three days, health care providers, governmental representatives, researchers, health care policy representatives and the general public will come together for an intensive discussion and respectful discourse. “We must listen to each other. Respect what we hear. Find the common threads and jointly weave a new fabric,” explains Dr. Marshall.


The Symposium

As director of Georgetown Lombardi’s Ruesch Center for the Cure of Gastrointestinal Cancers, Marshall is spearheading a symposium on this topic, scheduled for December 1-3, 2011 in Washington, DC. The Ruesch Center has invited thought leaders representing the major stakeholders, including the Food and Drug Administration, Centers for Medicare & Medicaid Services, National Institutes of Health, the private insurance industry, the biotechnology industry, legal and bioethics groups, patient advocacy groups, and practicing physicians to define “value in cancer care” from their perspectives.

The symposium will be divided into three parts; all are free and open to the public. On the afternoon of Thursday, December 1, from 1-3 p.m., speakers will share their perspectives on the timely topic: “Health Care Reform: Opportunity or Sacrifice?” David J. Kerr, M.D., who helped reform the United Kingdom’s National Health Service and has advised two British prime ministers on health care policy, will present the keynote lecture.

U.S. House Minority Whip Steny Hoyer (D-Md.) will deliver introductory comments. The December 1 event will be held in the Lohrfink Auditorium of the Rafik Hariri Building on the Georgetown University main campus.

On Friday, December 2, the topic will be “Defining Value in Cancer Care” and a variety of speakers and panel discussions will address the cost of cancer care in the United States, and the impact of guideline-based medicine, among other topics. Friday’s event will be held at the Georgetown University Law Center from 12:30-5 p.m. and will include introductory comments from M. Gregg Bloche, M.D., J.D., law professor at Georgetown University Law Center and author of The Hippocratic Myth: Why Doctors Are Under Pressure to Ration Care, Practice Politics, and Compromise Their Promise to Heal.

On Saturday, December 3, the symposium will shift gears to focus on patient care issues and will seek to tie the policy discussion back to the patient. Titled “Navigating Cancer Care: What Every Patient Should Know,” the Saturday event will offer insight from noted Georgetown faculty in cancer research and personalized medicine.

Among a list of esteemed speakers for the three-day event are: Louis B. Jacques, M.D., Centers for Medicare & Medicaid Services; Ira M. Klein, M.D., Aetna, Inc.; Gregory H. Reaman, M.D., U.S. Food and Drug Administration; Mona Sabharwal, Pharm.D., Pan-Canadian Oncology Drug Review; Margaret Mahon, Ph.D., R.N., F.A.A.N., George Mason University; Thomas J. Smith, M.D., F.A.C.P., The Johns Hopkins Medical Institutions, Sidney Kimmel Comprehensive Cancer Center; Paul J. Wallace, M.D., Center for Comparative Effectiveness Research, The Lewin Group; Jordan D. Berlin, M.D., Vanderbilt-Ingram Cancer Center; Antonio Tito Fojo, M.D., Ph.D., National Cancer Institute; and Louis M. Weiner, M.D., Georgetown Lombardi Comprehensive Cancer Center.

More information on the Ruesch Center 2011 Symposium, including a full agenda for each day and a link to register, can be found online.


By Lauren Wolkoff, Georgetown Lombardi Communications