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Posted at 9:50 PM ET, 02/15/2011

Law of unintended consequences

By Saqib Ali, North Potomac

Regarding the Feb. 14 editorial “Doctors and self-dealing”:

In general, restricting prescribing doctors from performing CT scans and MRIs is a good idea. But this editorial glossed over one defect in Maryland’s self-referral law. As a Maryland legislator, I tried to remedy this defect in 2008 and 2009.

Current Maryland law bans doctors from “self-referrals” for certain services because of the possibility of conflict of interest and fraud relating to over-prescription. These services include MRIs, CT scans and radiation therapy. But MRIs and CT scans are fundamentally different from radiation therapy in one important way: They are diagnostic tools, whereas radiation therapy is a treatment. While MRIs and CT scans can be prescribed for nearly any ailment, radiation therapy is given only to patients who are known to have cancer, and it has significant side effects. For this reason, the risk of over-prescription and fraud with radiation therapy is far lower.

Maryland law has the unfortunate effect of preventing doctors who perform chemotherapy from co-locating with doctors who perform radiation therapy. Patients who need both chemo and radiation (there are lots of them) end up unnecessarily shuttling between offices. In their weakened condition, it is a hardship. And it is a hardship that only cancer patients in Maryland must endure.

The writer, a Democrat, served in the Maryland House of Delegates from 2007 to 2011.

By Saqib Ali, North Potomac  | February 15, 2011; 9:50 PM ET
Categories:  HotTopic, Maryland  
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You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price search online for "Wise Health Insurance" If you have health insurance and do not care about cost just be happy about it and trust me you are not going to loose anything!

Posted by: kinglaura16 | February 16, 2011 4:51 AM | Report abuse

I agree that doctors should not self-prescribe. In the case of my wife who had stage 4 cancer, her oncologist refused to continue treating her, even for pain once she decided she could no longer tolerate the chemotherapy he was administering. It seems that selling expensive chemo has become the primary source of income for oncologists and basic medical care has become too unprofitable and mot worth their time.

Posted by: gbarnaby | February 16, 2011 9:46 AM | Report abuse

gbarnaby- the topic is not about physicians prescribing any treatments for themselves. The issue has to do with making treatments for patients with some types of cancers easier to access vs making it harder to access under the false impression that people would receive unnecessary care. In fact, the patients who would need both chemo and radiation treatment would still get both treatments if the well intended but poorly conceived law passes,but at different locations. As a person who has a family member with cancer I would think you would understand the hardship this would impose on those who are so seriously ill. I'm sorry your wife is ill.No medical professional would try to 'sell' her or you anything.Your wife decided not to use an available treatment, which is her choice.Generally speaking specialists do not provide primary care services, as these should be provided by your family doctor/primary care physician.I wish you and your wife all of the best.

Posted by: 10bestfan | February 16, 2011 10:36 AM | Report abuse

This "problem" is a side-effect of the majority of people not having to be directly responsible for the cost of treatment. Since the patient has no real stake in the cost then they never question whether they need the MRI, CT scan, etc. Most people know their car than their health and generally make no effort to find out either.

Not allowing physicians to perform radiation therapy with their own equipment does not make a lot of sense.

Posted by: rwdavis2 | February 16, 2011 12:02 PM | Report abuse

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