Chapter 11: A Brief History of PET Scans at MD Anderson
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Description
In this segment, Dr. Podoloff explains why PET scans were difficult to offer at MD Anderson. First, financial difficulties at the institution resulted in the PET program being closed between 1988 and 1994. Next, insurers were not reimbursing PET scans because there was no data to document their advantages. Dr. Podoloff discusses insurance and the damaging influence insurance policies can have on treatment. He notes that the PET program was restarted at MD Anderson in 1999 and currently does seventy to eighty scans per day.
Identifier
PodoloffD_01_20150402_C11
Publication Date
4-2-2015
City
Houston, Texas
Interview Session
Tacey A. Rosolowski, PhD, Oral History Interview, April 02, 2015
Topics Covered
The Interview Subject's Story - Overview; Overview; The Researcher; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Business of Research; Fiscal Realities in Healthcare; The Healthcare Industry
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey A. Rosolowski, PhD
I wanted to circle back to what brought us onto this conversation, which is the technological advances. And so we were talking about the PET/CT.
Donald A. Podoloff, MD
Yeah. Now the PET/CT had an impact almost as much as CT did. In a matter of a year to a year and a half, nobody was making PET scans anymore, they were only making PET/CT scans.
Tacey A. Rosolowski, PhD
Wow. Was 2007, was that when it—
Donald A. Podoloff, MD
I think the first papers came out in 2006 maybe. But that means they had been working on it probably for three to four years before that. Just nobody knew anything about it. It was always a dream, because as I told you, what we used to do in the old days is we’d have a CT over here and a PET scan over here. Our eyes would do the synthesis for us. But the first machine that actually did it—we didn’t get ours until around 2000.
Tacey A. Rosolowski, PhD
Oh, really.
Donald A. Podoloff, MD
Yeah, 2002, 2003 I think. Now Anderson has notoriously been very late into technology.
Tacey A. Rosolowski, PhD
OK. So you got a PET/CT machine in 2002, 2003?
Donald A. Podoloff, MD
We got our first PET scan in 1999.
Tacey A. Rosolowski, PhD
Oh, first PET scan, OK.
Donald A. Podoloff, MD
It was not really our first, it was our second. We actually had a PET program here from 1988 to ’94 but we had to close it.
Tacey A. Rosolowski, PhD
Why was that?
Donald A. Podoloff, MD
It was a huge economic drain on the institution.
Tacey A. Rosolowski, PhD
Huh.
Donald A. Podoloff, MD
And at that time PET was not reimbursable, so you couldn’t charge patients a clinical fee for doing it.
Tacey A. Rosolowski, PhD
I see. So was that decision to close down the PET program purely financial? Or was it not demonstrating value in terms of care?
Donald A. Podoloff, MD
Oh, it had nothing to do with science, it was purely—were you here in ’94?
Tacey A. Rosolowski, PhD
No, I came in 2011.
Donald A. Podoloff, MD
OK, so you’re relatively new. In 1994 we were told that in 1995 we’d be half our size. Managed care was coming, and it was going to destroy MD Anderson. And our leaders, being responsible humans, listened. And so they closed programs. And PET was one of the casualties of that.
Tacey A. Rosolowski, PhD
OK, I do recall that period in the institution’s history.
Donald A. Podoloff, MD
You’ve interviewed people who probably are still pissed off about that.
Tacey A. Rosolowski, PhD
Yeah. I mean it was a painful time for the institution.
Donald A. Podoloff, MD
Very. It was the first time that the institution ever had to do anything like that. And it was actually before ’94. It was more like ’92, ’93.
Tacey A. Rosolowski, PhD
The Sharp report came out.
Donald A. Podoloff, MD
Yeah, exactly. Where are they today, by the way?
Tacey A. Rosolowski, PhD
Don’t know.
Donald A. Podoloff, MD
Yeah. Where’s MD Anderson? They were all wrong. All those experts were wrong.
Tacey A. Rosolowski, PhD
Oh, yeah, absolutely. Yeah, well, I mean when John Mendelsohn came he decided he was going to ignore that wisdom as nonwisdom, and grow the institution. And I think there are people who are still talking about the fact that a lot of the people who were let go during ’94, ’95 were hired back. So it was a very strange period. How do you tell which way the wind is going to blow?
Donald A. Podoloff, MD
Yeah. It was a very serious miscalculation of what was going on. But it was the prevailing wisdom.
Tacey A. Rosolowski, PhD
Absolutely.
Donald A. Podoloff, MD
I remember J [Freireich] at that time was saying, “These guys are crazy. They’re going to have more patients than they know what to do with in five years.” And he was right.
Tacey A. Rosolowski, PhD
Huh. Now is the reason that PET scans were not reimbursed at that time, was it a lack of information that was being provided to insurers?
Donald A. Podoloff, MD
There was no clinical data that suggested that it was better than nothing. And it was very expensive. And it got its start in brain research. And then they started to do cancer work with it. The way PET got reimbursed was through a study done by a group who demonstrated to CMS—I don’t think it was called Medicare at that time, it was called CMS—that a PET scan—this is just plain PET—reduced futile thoracotomies by twenty percent, because it found a metastatic deposit somewhere that you—like an adrenal lesion or a bone lesion, which means you’re not an operable candidate anymore.
Well, a thoracotomy was more expensive by far than doing a PET scan. And that’s why the government approved PET scanning for lung cancer.
Tacey A. Rosolowski, PhD
Now was that study done at MD Anderson or someplace else?
Donald A. Podoloff, MD
No. I don’t remember where it was done now. But it’s a very famous study. I probably have it in my slides. But that’s how PET started to get reimbursed. And now, well, it’s been a long time, but there are groups of people who are working very diligently on demonstrating that when you do this test you save money in the long run. And that’s really the only thing that the government—the government is not going to respond to well, the outcome is better and the patient feels better. They’re going to respond to the macroeconomics of the situation.
Tacey A. Rosolowski, PhD
I’ve been talking to Linda Elting in Health Services Research. And it’s been a very interesting conversation about how providing this hard data to insurance companies makes an enormous difference. And I mean in her words she says insurers are not in the business of denying people care, they’re in the business of denying useless care. (laughter)
Donald A. Podoloff, MD
Yes. But most insurance companies are for-profit organizations. And so their bottom line is they have to be profitable. Well, denying care that’s ineffective is a very good way to help that bottom line. But denying care that is effective is just as good a way of doing that.
Tacey A. Rosolowski, PhD
Absolutely. So when did MD Anderson get its PET program back? You said 2002?
Donald A. Podoloff, MD
I think we started it up again in 1999.
Tacey A. Rosolowski, PhD
OK, 1999.
Donald A. Podoloff, MD
I was given permission to recruit Homer Macapinlac here.
Tacey A. Rosolowski, PhD
I’m sorry. His name?
Donald A. Podoloff, MD
Homer Macapinlac. He’s the chair of nuclear medicine. And I recruited him from Sloan-Kettering. And I recruited Osama Mawlawi who’s a physicist. And they started the PET program for us. And very quickly we became the largest and most successful PET program in the United States, and still are. Nobody does seventy or eighty scans a day like we do.
Tacey A. Rosolowski, PhD
Wow.
Donald A. Podoloff, MD
I’m watching the time because I have something else that I need to do.
Tacey A. Rosolowski, PhD
OK. Would you like to stop? Do you need some time to transition?
Donald A. Podoloff, MD
No, I’m OK about transitioning. I want to leave you with a thought.
Tacey A. Rosolowski, PhD
Sure.
Recommended Citation
Podoloff, Donald A. PhD and Rosolowski, Tacey A. PhD, "Chapter 11: A Brief History of PET Scans at MD Anderson" (2015). Interview Chapters. 739.
https://openworks.mdanderson.org/mchv_interviewchapters/739
Conditions Governing Access
Open
