NEW YORK — It is a unique situation in medicine: Unlike other kinds of doctors, cancer doctors are allowed to profit from the sale of chemotherapy drugs.
"The significant amount of our revenue comes from the profit, if you will, that we make from selling the drugs," says Dr. Peter Eisenberg, a private physician who specializes in cancer treatment.
Doctors in other specialties simply write prescriptions. But oncologists make most of their income by buying drugs wholesale and selling them to patients at a marked up prices.
"So the pressure is frankly on to make money by selling medications," says Eisenberg.
Ethicists see a potential for conflict of interest.
"They might have a preference to give you the one that they're going to make the most money from," says Arthur Caplan with the University of Pennsylvania Center of Bioethics. Caplan also writes MSNBC.com's Breaking Bioethics column.
This unique payment system started years ago because Medicare and insurers wanted to save money by moving cancer treatments out of the hospital. But it has come under increasing scrutiny as prices for some cancer drugs skyrocketed to tens of thousands of dollars a year.
That's a lesson patient Cynthia Adams quickly learned.
"I almost had a heart attack when we got the first insurance statement," says Adams. "It was pretty outrageous."
Dr. Eisenberg, like many of his colleagues, does not like the system.
"Patients should feel that their physician has their best interest at heart, always," he says. "And the way the system is set up, because of the incentives, does something to destroy that."
Three years ago the government tried to fix the system by cutting back on the amount doctors got for the drugs and trying to find ways to pay the doctors more for other services, like spending time with the patients. But many experts say the underlying problems remain — with the potential for patients to get expensive drugs for the wrong reasons.