New York Times MD Anderson 25 Oct 09

Front page of today's NY Times is long story about M D Anderson Cancer Center. The story talks about how people with rare cancers are referred to M D for best case treatment.
However, there are other reasons why a local primary care doc would refer someone to MD
Grief avoidance - not that many primary care docs have the mental toughness to deal with a 34 year old with an incurable cancer.

Money - It is quite possible that for the exact same treatment, MD gets paid more then a local doc, so the same treatment is profitable at MD and a loss for a local doc

Lawsuit avoidance - if a person dies of a rare cancer, who is more likely to face a malpractice lawsuit, a primary care doc who may never have seen this type of tumor before or MD Anderson ? Clearly, if a patient with a rare tumor, under the care of a local doc, dies , it is the doc's fault; if that same patient dies at M D, it is an incurable tumor.

Playing God - perhpas the primary care doc knows full well that the cancer is incurable, but decides it is his (the docs) perogitive not to tell the patient this, but to send him to MD go generate a sense of false hope, that the doc thinks, will sustain th patient

Illegal medical research - It could be that the local doc knows quite well that the cancer is untreatable, and that going to MD is not going to do anything, but , playing god, offers the patient as a guinea pig. Now this would be quite acceptable if the doc was honest, and said to the patient, you have an incurable cancer and have two choices - I can provide you with palliative care, to make your remaining time as comfortable as possible, or you can go to M D Anderson and be a guinea pig; if you do this, you will experience months of extreme discomfort, and there is a very small chance that what they learn will help anyone else; but it is your choice.