To the Editor: I have seen our specialty make an impressive impact on the lives of cancer patients in my 20 years of medical oncology practice in my multiethnic, working-class Southern California community. We have both prolonged and improved patient survival. Nationally and locally, oncology professionals have facilitated these improvements and developed and supported the clinical trials methodology to develop and evaluate new cancer treatments. In this same period, however, newly underinsured patients have emerged as part of a disturbing national economic trend. As oncology's pharmacologic arsenal has grown in efficacy, there also has been an unprecedented growth of pharmaceutical costs. In my practice, pharmaceutical expenses have increased from less than 10% to 60% of monthly expenses, mirroring national trends.1 Increasing numbers of my patients are unable to afford their copayments, deductibles, and pharmacy bills. In spite of our best efforts to mitigate the effect, between May and September 2005, 34 of 179 patients screened by our practice's business office declined all or part of recommended therapy for reasons of cost. We are now encountering many of the Institute of Medicine's concerns about uninsured patients' health in this population.2 There is less likelihood of patients' receiving professionally recommended standard care, less likelihood of receiving medications that are standard treatments, diminished health-related quality of life, and increased risk for adverse health events and health care cost–related bankruptcy. In other words, medical oncology professionals and patients are facing a critical point at which financial circumstances may overwhelm our ability to care for patients. How can we solve this problem? Jacque Sokolov, MD, the medical futurist, has offered a solution to many of the health economic dilemmas facing the United States in the 21st century. He proposed that this solution can be accomplished through a business process known as clarification. The goal is economic transparency (defined as knowledge of the economic value of goods and services before they are purchased).3 The U.S. health care industry and its customers need to understand prospectively the true economic value of our services and medications. In my opinion, the most logical way to accomplish this is by designing all clinical trials to specifically answer questions regarding the real dollar costs and benefits of each therapeutic option. On the basis of this information, we can make more rational decisions about oncologic health care expenditures. Until now, most segments of this industry have assiduously avoided asking and answering these questions. A PubMed search in August 2005 yielded 1,203 citations for “breast cancer, phase III,” but only six citations for “breast cancer, phase III, pharmacoeconomics.” The reasons for this avoidance are overwhelmingly complex, and it would be counterproductive to attempt to review this. Instead, the crucial issue should be how to start this transition process. The best way for this transition to happen is for all stakeholders to adopt this change in orientation with oncology health care professionals acting as catalysts. All involved interest groups will need to contribute to the effort. However, oncology professionals must take an advocacy position that maintains financial neutrality without compromising patient care. Only experienced cancer specialists can ensure both optimal patient benefit and transparency. This will also ensure that medical oncologists' primary focus will remain the health and well-being of the residents of the United States in this arena of economic uncertainty. Successes in treating cancer have created terrible economic dilemmas for our patients. Oncology professionals are in a unique position to facilitate needed change by pharmacoeconomic approaches. Unless we lead the way, our entire cancer care delivery system is at risk.