This article is more than 5 years old. Information may no longer be current.
‘Covfefe’ — the real meaning
The world was agog when the “First Tweeter of the United States,” or FTOTUS, in an early morning commentary used the mystical term “covfefe.”
White House Press Secretary Sean Spicer made it clear that a small, highly select group knew exactly what this neologism connoted, and the outer circle intimated that it might be a secret message to — or about — Russia. The situation, unresolved, has spawned continued discussion and angst among anxious and uncertain beltway groupies.
Health care uncertainty
At present, my world also is facing some uncertainty in the absence of well-defined health policy for the future at state and federal levels.
There also exists the highly problematic situation in which support for the health care of up to 24 million citizens may be disappearing, in addition to a harbinger of reduced 2018 funding for research at a time when the return on investment from research is at an extraordinary zenith.
Moreover, the approach to containment of health care costs seems to be fractured, at best. This is a huge problem, as the uninsured and underinsured will choose not to risk fiscal disaster by avoiding or delaying treatment. This will gradually extend to well-insured patients who still encounter copays at a staggering incremental rate. Remember that a 15% copay on a treatment course of the novel immunotherapeutic agents could be as high as $100,000 or more.
I have just returned from attending a meeting of a newly convened think tank — the Value in Cancer Care Consortium (Vi3C) — focused on the specifics of cost reduction in oncology, held at the ASCO Annual Meeting. As described in my past columns, ASCO has been very active in the policy space in trying to reduce unnecessary costs of cancer care without sacrificing quality or outcomes.
This think tank focused more on the specific issues of considering an improvement to oncology value, leveraging our emerging knowledge of the pharmacological equivalence created by dose modification (eg, administration of certain oral medications with specific foods to alter the pharmacokinetics and reduce the oral dose), leading to cost reduction and, thus, equity for the impoverished.
At its simplest, this could be summarized as Considering Oncology Value by Finding Equivalence For Equity, or, “COVFEFE!”
So, perhaps the quixotic and convoluted thinking of FTOTUS is to encourage the oncology community to take a strong stand and self-police to bring down cost, in turn hoping that the pharmaceutical and molecular diagnostic industries and the manufacturers and vendors of health care equipment will follow suit by lowering their prices to reflect reality and not venality.This whole concept is not completely new, and there are several key categories — with attached practical examples — in which this can be achieved (see Table).
Grassroots movement
The Vi3C is now considering the initiation of several collaborative multisite trials amongst its membership, focused on delivering reduced costs of care to the community.
This will be yeoman’s labor, and nothing like the sexy science that will produce headlines in our leading medical journals — which mostly prefer sexy science. However, it has the potential to reduce by more than 50% the costs of chemotherapy and radiotherapy in the management of cancer.
Hopefully the American College of Surgeons will review this initiative and focus on complex surgical procedures that are unnecessary, or which do not really contribute to significantly improved survival.
Thank goodness there is now a grassroots movement in the oncology community that is focusing the attention of some very fine oncology leaders on collective personal initiatives, hoping to develop evidence-based information, that will lead to dramatic cost containment.
Who would have thought that a 3 a.m. tweet of “covfefe” might have launched all this?
For more information:
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, is HemOnc Today’s Chief Medical Editor for Oncology. He also is president of Levine Cancer Institute at Carolinas HealthCare System. He can be reached at derek.raghavan@carolinashealthcare.org.
Disclosure: Raghavan reports no relevant financial disclosures.