Dr. Kenneth B. Blankstein, an oncologist in Flemington, N.J., is treating a woman for lung cancer. She responded well to the first chemotherapy drugs he prescribed. When her health was stable, he gave her a “temporary break” from chemo to spare her some of its side effects.

But when he tried to return her to the treatment, the insurer balked, saying that the “temporary break” was evidence that the treatment had failed. Despite Blankstein’s protests, the insurer said she would have to move next to Tarceva, another treatment.

“She had under a 5 percent chance of a response on Tarceva,” he said. “Yet they insisted, so we had to.”

As Blankstein expected, the patient did not respond, but instead of letting her return to the first chemo cocktail, the insurer insisted she try another drug first.

The patient ultimately switched to Medicare, which covered the first chemotherapy protocol. Her health is stable.

“The patient’s being told to use a drug we know isn’t going to work, but we have to use it anyway for someone with terminal illness? To me that’s just insane, but it’s the way they do things,” Blankstein said. “It’s taken away clinical judgment. It’s managing by algorithms.” Read the whole article.