Incentive Problem in Cancer Drug Trials
I saw this brief New York Times article syndicated in the San Jose Mercury News. Evidently, one of the challenges in identifying new cancer treatments is recruiting enough patients for drug trials. The issue is that oncologists have little incentive to encourage their patients to enroll in drug trials.
Evidently, 60% to 80% of an oncologist’s revenues come from providing chemotherapy. When a patient enrolls in a trial, his doctor loses that revenue. As Scott Schaefer recently posted, the evidence is pretty clear that doctors respond to financial incentives. Result: a dearth of volunteers. So here’s an idea. Let’s pay a significant finder’s fee to oncologists that refer patients to trials. You could even start a “charity” to do this.
Possible Insight 
More generally the same is true of any prospective treatment that has high costs to the developer or manufacturer. Thus the well-documented “incrementalism” and low-risk research.
I like your idea of a charity that gives finders fees for clinical trials, but how do you calibrate it so that it doesn’t swing the incentive too far in the other direction?
rafefurst
August 17, 2009 at 12:27 am
I would build a database of chemotherapy profit per patient by zip code. My starting price would be 10-25% over this to overcome friction. Then I would titrate until supply and demand were equal.
kevindick
August 17, 2009 at 2:59 pm
Clincal trials do in fact due pay a reasonable per patient fee to clinicans who enrol people in approrpriate trials. I don think the issue is one of money–its the TIME involved with going through all the legal and consent issues, and supporrtive structure of the institions–clinical trial nurses, data manages, event monitorirng etc. All unfortunatlely are not priortized enough.
sherin
September 14, 2009 at 9:43 am
A proposed solution ( though admittedly not popular) would be to push for centralized cancer centers supported by government funding and less dep on fee for service providers. This would avoid the widespread duplication of expertise and commericial bias introduced by competing hospitals trying to keep the patient in their referral system. Would allow for qualtiy and outcomes data tracking of cancer care as well.
sherin
September 15, 2009 at 8:58 am