Today wBroccolie will start a new weekly feature that focuses on the world of the “code”.   Most patients are oblivious of the fact that physicians have given up their professional status for the most part to that of representing an insurance interest.  In fact many academic MDs who are comfortably positioned in a tenured university position argue that clinical decision making should above be centered around that which is best for the overall “public health”.  Would “resource allocation” best serve the broader community if grandpa did or did not get that new hip or heart valve, for example.  The ever-evolving Current Procedural Terminology codes — aka, CPT codes — continue to influence and mold clinical decision making.  There is a direct relationship between this CPT culture and the reason why oncologists are tone deaf about diet…

These are the specific codes that physicians and other healthcare providers must use to describe what they did with or to a patient.  Without that code — and strict adherence to what that code stands for — they simply don’t get paid.  That payment is based on the specific code and the general level of discounting and skimming that the insurer performs before issuing the check or deposit.  In one sense it is the reason that companies like United HealthCare and Anthem have the nicest building in town.  It’s where the money is and goes.  But I digress…

So, Dr Jones sees Mrs Johnson, who has breast cancer.  This visit is a function of recording the clinical history and status, performing an exam and/or reviewing recent lab work, then deciding on the ongoing course of treatment and further testing if necessary.  Diet is almost never mentioned.  Occasionally, a registered dietician will see the patient, but this is exceptional.   The advice is often a repeat of the “eat your fruits and vegetables” mantra.  It is difficult to browse sources of non-conventional cancer management without learning that sugar fuels the growth of most malignancies.  And yet so many patients hear little re diet from their trusted oncology consultants.  Usually it is an “eat whatever pleases you” type of response when this topic comes up.  This is especially true if the cancer patient is losing weight as often happens when things are getting out of hand.

Finally, after decades of evidence to the contrary, JAMA brings us the truth their editorial board has been hiding:  diet matters.  Breast cancer is less likely to recur if the “nightly fast” is lengthened somewhat.  Who knew?  Well, storied nutritionist, Pat Quillen, has known this for a long time as have his readers for the past 20 years.  For years I have recommended Pat’s books as a primer re diet and cancer cell growth.  Most of my oncology colleagues simply smile or roll their eyes.

The real question is just what drives oncologists to totally ignore such facts for the most part.  I would submit that the answer lies in the business model.  Oncologists are paid — as are most of the rest of the MDs dependent on the CPT codes for getting paid — by the code, not by the advice they give.  The irony here is that the American Medical Association actually OWNS the coding manual.  You cannot make this stuff up.

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