If Richard Sherman Says It, It Must Be True

If you live in Seattle and watch television, you've no doubt seen the commercial I've embedded above for the Swedish Cancer Center.* I'll give you a moment to watch it and be inspired.

Feeling inspired? If not, feel free to Google "youtube swedish cancer personalized medicine" and you'll find a host of similar commercials in their campaign -- including one featuring Seahawk Richard Sherman -- that you can watch and come away feeling like the cure for cancer is own our doorstep. A little DNA analysis, some "personalized medicine," and poof! -- cancer cured.

Yeah, not so fast.

Swedish isn't the only cancer doing gene analysis on tumors, and when I switched to the SCCA my oncologist there ordered a sample of my tumor undergo genetic analysis -- or, rather, "targeted genomic seq analys," procedure code 81455.* You might be surprised that I have this information so close at hand, but I got a letter from my health insurer which provided me with the identifying information for this test. The letter also explained that "Coverage of the above procedure code(s) is denied because Regence Medical Policy determines the service to be investigational due to the fact that the published clinical evidence is insufficient to conclude that this procedure is effective to improve outcomes." 

Fair enough, but now I have questions:

If the statement in the letter is true, why is Swedish running around telling the cancer patients of Seattle that this genetic testing is the secret to better treatment outcomes? Wouldn't this fall into the category of false advertising?

Additionally, regardless of the validity of this testing, given the healthcare environment in which we all operate, and the assumptions we all make about the distribution of costs, it seems a little off for Swedish to be pushing care for a potentially terminal disease that most patient's insurance won't cover.

And why do the two oncologists I've seen both think that genetic testing does improve treatment if the "published clinical evidence is insufficient"? Are the doctors convinced it helps not publishing? Or do doctors and insurance companies operate on different standards of sufficiency?

Oddly, one of the doctors I saw said that the real advantage of the testing is that it prevents them from giving you drugs that don't work. Standard treatment is to give everyone with my cancer the same chemotherapy drug, but it doesn't work on people with a particular genetic mutation. They find the mutation, they switch to a different drug. You'd think the insurance company would be persuaded by that argument, given how freakin' expensive the drugs are.

Ah well. I'm just a patient. What do I know? Well, I know I'm probably going to get a multi-thousand dollar bill for some DNA testing, but that doesn't really count. And circling back to where this post started, I also know that there's something about the way Swedish markets its cancer center that seems wrong to me.  


* It's weird to think my tumor is just sitting in a jar** somewhere waiting for someone to poke at it. 
** Ok, yeah, it's probably not in a jar, but you get my point.