August 15, 2010

Death panel.

"[F]or the first time in history, an FDA-approved anti-cancer therapy may not be covered by Medicare."

IN THE COMMENTS: Irene said (after I said "Picture someone who wants that drug to live. It isn't funded. FDA approved, but you can't get it under Medicare. We don't have to go by their euphemisms. Why isn't "Death Panel" an appropriate statement and an important way to create alarm?"):
If Avastin is what stands between you and death, then yes, "Death Panel" is an "appropriate statement" and yes, it is appropriate to cause alarm.

Full disclosure. I have advanced ovarian cancer. Hello friends and relatives.

The statistics for my stage of ovarian cancer (Stage IIIc) project an 18% survival rate two years after diagnosis.

I took part in a clinical trial for Avastin. My provider recently revealed to me that I received the test drug.

I am approaching that two-year mark of initial diagnosis, and so far, I am doing well. I attribute that good result to Avastin, which prevents the regeneration of cancer cells. Yeah, I had some lousy side effects, but it seems to have worked.

Thank you, and good night, Irene.

UPDATE: The Washington Post has a long article about this controversy over Avastin.
The Food and Drug Administration is reviewing the recommendation of influential scientific advisers to revoke authorization of the drug to treat metastatic breast cancer. Contrary to initial research, new studies indicate that the benefits of the drug, which costs $8,000 a month, do not outweigh its risks, the advisory panel concluded.

Citing a dearth of evidence of the drug's effectiveness, its potential toxic side effects, and its high cost, many cancer experts, patient advocates and others are welcoming the prospect that Avastin's authorization for breast cancer might be repealed. But the possibility is alarming other cancer specialists, women taking the drug, some members of Congress and advocates for giving patients as much access to as many treatments as possible.
The FDA is not supposed to consider costs in its decisions, but if the agency rescinds approval, insurers are likely to stop paying for treatment.

"It's hard to talk about Avastin without talking about costs," said Eric P. Winer, director of the Breast Oncology Center at the Dana-Farber Cancer Institute in Boston. "For better or worse, Avastin has become in many ways the poster child of high-priced anti-cancer drugs."
In the cost-benefit analysis, your improved chance of living may not be worth $8,000 a month.

197 comments:

Pogo said...

"If they will die without the cancer drug, they had better do it, and decrease the surplus population."
- Ebenezer Berwick

Methadras said...

What did we think was going to happen? They certainly aren't being called Life Panels are they?

Pogo said...

"However, with respect to Provenge, it appears that CMS is arguing that while the treatment is safe and effective, it may not be reasonable and necessary."

Something so stupid, only an intellectual would believe it, or an example of shameless obfuscatory political bullshit.

Bartender Cabbie said...

and so it begins?

peter hoh said...

This is why I think that people ought to be paying for a larger share of their medical coverage.

If the government is footing the bill, any effort to curtail spending is the government telling people to drop dead.

And if the government commits itself to footing the bill, no matter what the cost, we're going to see more drugs like Astavin, which cost something like $50,000 to $100,000 for a course of treatment.

traditionalguy said...

Tom Malthus of famous English perspective has at long last been imported by King Obama I. So how many useless drones are too many useless drones? After all there is no rational basis for laws favoring life over a cheap and necessary death...such laws would have to be morality based and therefore clearly could not be a legitimate purpose under a Constitutionally constrained government. UNLESS, that government's health Insurance benefits given for life to Congress, Executive and Judicial branches are ever being challenged. Hasta la vista old folks.

Milwaukee said...

Oh common on. "Death Panel" is an expression that hockey mom from Wa, from Wa, from up north made up. Geewilickers. Nowhere in the Health Care Reform Act does the expression appear. Scare mongers. (That was meant to be sarcastic.)

Berwick made sure that his previous employer gave him a health plan so grand that even after he left there, he is covered, and will be for the rest of his life. National health care for us, not for him.

So now they have noticed that fructose helps tumors grow. So perhaps the "5 alive" program wasn't such good advice, pushed by the government. Some fruit everyday, but more vegetables than fruit are needed to be healthy. But in the end, we can only do so much and our bodies will betray us. But I would sure hate to be dying knowing that simple things could have been done to prolong my life and ease my pain, and weren't because of bureaucracy or finances.

peter hoh said...

Trad guy, if I came up with a treatment that cost $5,000,000 and extended the life of a colon cancer patient by two months, do you think the government should pay for it?

Rialby said...

Did anyone see 60 Minutes last week? They reran a piece that was probably done pre-passage of the HC bill. Long story short, they followed around a doctor who was trying to convince people to die. It was charming really. I was waiting for someone to apologize to Sarah Palin. No such luck.

Milwaukee said...

peter hoh:
I would agree with people paying for a bigger share of their health care bill, particularly the deductible. Health insurance should be for catastrophic problems. When I leave the health care provider I frequently have no clue what something costs until after I see paperwork from the insurance. My understanding is that in India people pay the health care provider at the end of the visit. And they are much more conscientious about what things cost. Sort of like the mini-bar at the hotel, if you have no clue what things are going to cost, you are much more likely to grab a bunch of stuff you really don't need. We are developing a moral hazard: people don't feel as personally responsible because the gov is going to bail them out.

Kirby Olson said...

Prostate cancer is a shoe-in for Obama. Men tend to vote against him.

I couldn't understand why he would ban the breast cancer drug, though.

Maybe it's because older women tend to vote against him.

Ann Althouse said...

"Nowhere in the Health Care Reform Act does the expression appear. Scare mongers."

What are you saying? Picture someone who wants that drug to live. It isn't funded. FDA approved, but you can't get it under Medicare. We don't have to go by their euphemisms. Why isn't "Death Panel" an appropriate statement and an important way to create alarm?

fboness said...

This is the way it is done in Britain's NHS. Berwick will recreate the glory of NHS in America.

sunsong said...

this was predicted. Good healthcare does not come from government bureaucrats. In fact, what does?

But it is criminal to assign one man or a panel of men and women to determine what is *good* healthcare for 300+ million individuals. That is, imo, inexcusable. We are all different, unique. What works for one - does not work for another - and something else for still another.

What the government giveth - the government also taketh away.

edutcher said...

When the campaign was going in '08, there was the story of the woman in Oregon who wanted to know what cancer therapies were included in her state's version of RomneyCare and got a pamphlet on assisted suicide.

Those who opposed The Zero warned this was going to happen, but Obambi was too sweet and good to do that, his friends said.

If this thing isn't repealed, there will be all kinds of trouble.

Irene said...

If Avastin is what stands between you and death, then yes, "Death Panel" is an "appropriate statement" and yes, it is appropriate to cause alarm.

Full disclosure. I have advanced ovarian cancer. Hello friends and relatives.

The statistics for my stage of ovarian cancer (Stage IIIc) project an 18% survival rate two years after diagnosis.

I took part in a clinical trial for Avastin. My provider recently revealed to me that I received the test drug.

I am approaching that two-year mark of initial diagnosis, and so far, I am doing well. I attribute that good result to Avastin, which prevents the regeneration of cancer cells. Yeah, I had some lousy side effects, but it seems to have worked.

Thank you, and good night, Irene.

Joe Giles said...

Quality, affordability, universal access.

Pick any two.

Rialby said...

I wanted quality and affordability along with market-based system that rewarded drug makers for bringing new, effective drugs to market.

peter hoh said...

Althouse, how much is too much?

If every patient starts racking up a million dollar tab, where's the money going to come from?

Pogo said...

This should go over well on The View.

c3 said...

In a phase 3 trial of 512 patients (randomized in a 2:1 ratio to 341 patients sipuleucel-T and 171 placebo), patients with metastatic castration-resistant prostate cancer, who had failed hormone treatment, had a 4.1-month improvement in median survival with sipuleucel-T (25.8 months with sipuleucel-T vs. 21.7 months placebo). 75% had Gleason score ≤7. Median PSA was 51.7 in the treatment group.[3] This treatment has an estimated cost of $93,000 per month

And so far the studies are very small. So it may be slightly beneficial but at a cost of ? (you can do the best and worst case scenario math yourselves)

So the wealthy are afforded the opportunity to spend several hundred thousand dollars to extend their lives a few months.

I know this will sound harsh but someone has, does and will say for some therapies:

I'm not saying you can't have it; I'm saying this payor won't pay for it

Fred4Pres said...

Andrew Sullivan will weep and gnash his teeth if Palin is proven to be right.

Michael McNeil said...

if I came up with a treatment that cost $5,000,000 and extended the life of a colon cancer patient by two months, do you think the government should pay for it?

Maybe. Economies of scale together with rapid technological advances would likely quickly bring that cost down dramatically. Look at the human genome decipherment project, for instance, that took ten years to do (1990-2000) and cost billions of dollars — however, due to rapidly advancing technology, probably 90% of the work was accomplished in the last couple of years.

Since then, for a number of years now the cost of doing an individual DNA decipherment has been falling at an order of magnitude a year, which soon is expected to reach a mere $1,000.

Big Mike said...

@Peter, where did it say that Provenge costs a million dollars?

If you had inoperable prostate cancer, how would you feel about the CMS ruling?

Assuming your gender is male, as implied by your handle, prostate cancer is not an unlikely disease for you to have to deal with some day.

Trooper York said...

Obama will have a lot to answer for on Judgement Day.

Pogo said...

"peter hoh said...
If every patient starts racking up a million dollar tab, where's the money going to come from
"?

1) How much is too much? Berwicks's beloved NHS limits annual patient spending to $30-$40K, beyond which, NHS does not provide coverage.

2) Where is the money going to come from? Shit, you lefty twits, if you had no idea how you were going to pay for all this, why'd you take over health care? Goddamned assholes.

Milwaukee said...

Before the stock market recent collapse, I heard an author being interviewed on NPR. Seems she had written a book about the incredible profits of the pharmaceutical companies. Now this was before energy prices sky-rocketed, but at that time the top 5 pharmaceuticals had a combined net profit which exceeded the combined net profits of the other 495 companies on the Fortune 500 list. The author? Can't remember her name. But I do remember that she had been the editor of some magazine. Maybe the New England Journal of Medicine. Anybody ever heard of such a publication?

The pharmaceuticals spend vast amounts on advertising, and on schmoozing doctors, and some on research. But research money is stretched by government money, and they spend vast amounts playing with copyrights to keep drugs out of the generic realm. So we subsidize them big time.

None of the above was meant as sarcasm. Really. I don't mess around with that stuff.

peter hoh said...

We CAN spend a lot of money on X, Y, and Z.

That doesn't mean we should.

PatCA said...

Irene,
Two years...that is good news, great news. I hope you have many more years.

traditionalguy said...

Peter Hoh...The cost is always one of the cruel facts of life. I just say that we need to care for the weak and the helpless as best we can. We can do that voluntarily through private Church sponsored programs the day after the US and the State cleptocrats cut re-distribution taxation rates in half and also refund to us all the Medicare and Social Security money taken from our and our employers' pockets during our lives that they say is now "Held in Trust" for us. We could call it Private Health Insurance. The Tea Party started on this very issue. They need to throw the bums totally out this November. It is a life and death reason to vote.

Milwaukee said...

We are a cranky people. What's going to happen when we have individuals who say "screw this. I'm going to die, they aren't going to give me medicine. Where is my shot gun, I have some scores to settle, and I might as well go out taking an idiot with me." We already had a cancer patient stalking Osama bin Laden.

PatD said...

You do not get cheap treatments until someone has paid for the first, expensive treatment. The first heart transplant was extremely expensive; these days, my janitor can get one (true). The first AIDS drugs were very expensive; today AIDS is a chronic disease. It is the private sector that drives down costs, because that it is how it maximizes profits. This is an utterly alien concept to socialists, progressives, Democrats and like-minded elites. They simply can't comprehend how evil Walmart could enter the prescription drug market and drive down the cost to the consumer.

Even worse, they don't realize that Socialist healthcare systems, like the NHS, or the Canadian system, have been free-loading off of US innovation. When the US goes Obamacare, healthcare innovation will grind to a halt.

Pogo said...

We, peter hoh?

What's this "we" bullshit?

Someone died and made you king, and it's a royal 'we'?

sunsong said...

Irene,

I am so sorry you are going through this. Thank you for being so vulnerable and sharing what you did.

It is my prayer that this travesty is corrected.

sunsong said...

I'd like to hear from those who are arguing for rationing:

why did/do you want government making these decisions? If you believe that healthcare ought to be rationed because it is so expensive - what was wrong with insurance companies doing the rationing?

kcom said...

My friend, who is a young mother (with kids 3 and 1), was recently diagnosed with stage IV colon cancer. She is receiving Avastin as part of her chemotherapy. I assume her insurance company is paying for it. The depressing thing for me is that in reading up on Avastin (which she is getting every other week for 11 weeks at $5000 a pop) is that it doesn't even pretend to be a cure. According to what I read, it's documented to extend life an average of four months, but does not change the overall survival rate. That's a lot of money for something that makes a difference that can be measured in only months.

Perhaps ovarian cancer is different, but this drug is apparently not standing between my friend and death. It's just delaying it for a bit. Unless the other (much cheaper) drugs she is receiving actually cure her, Avastin won't make any long term difference. Her odds aren't great, but cure sounds better than four extra months.

Irene said...

PatCA, thanks. It takes a little courage to step forward.

sunsong, I appreciate the thoughts. I don't feel especially vulnerable, in a way, it's a relief to know "what is going to get me." I think of Christopher Hitchens when I reflect on that.

kcom, the effect on ovarian cancer still is uncertain. But hey, for me, four months is a real treat. Worth every cent.

Penny said...

"Death panel"

Soon enough our deaths will be decided by a panel of reality TV hosts.

ha ha

Betcha ten to one I could make it to Las Vegas for the REALLY big show.

And if Celine Dion went back to Canada, and Wayne Newton retired? I feel certain I could live forever!

Maguro said...

Perhaps ovarian cancer is different, but this drug is apparently not standing between my friend and death. It's just delaying it for a bit.

The same could be said of any medical treatment. Death always arrives in the end, does it not?

JAL said...

Told you so.

Luke Lea said...

As a former cancer patient I know that the typical "successful" new chemo treatment extends life a couple of months but the quality of life is miserable and the costs very high. Chemo, which is basically poison, is positively medieval. Quality of life with people you love in more important at the end in my opinion.

peter hoh said...

Big Mike, I'm asking how much is too much. I'm not getting into the specifics of this one drug.

I am male, and my wife's father just died of prostate cancer. It's not hypothetical to me.

Nonetheless, I don't think that a cancer diagnosis ought to be a blank check, entitling one to spend huge sums of other people's money for limited return.

Any insurance program, private or public, is going to have to set limits in the face of expensive treatments. Do you want across the board spending limits? If not, what sort of system would you propose for balancing cost and effectiveness?

I tend to trust people who spend their own money to make decent decisions, but I can't see us moving our health care system to a cash on delivery system.

Pogo, if you bothered to go back through the health care debate posts, you won't find that I championed the bill. You will find that I objected to the death-panel rhetoric, and that I noted that before he was against it, Newt Gingrich had praised a LaCrosse, Wisconsin program that was similar to what Johnny Isakson proposed.

peter hoh said...

Pogo, since when has it been improper to use "we" when talking about our government?

We spend money on defense. We were attacked at Pearl Harbor.

That's not the royal we.

reader_iam said...

All I can say is that in my most recent experience with *both* Medicare AND private insurance (note that I said "most recent," as opposed to only), *both* are *both* sadly lacking and ruthless, but above all, mostly concerned with pro forma and not with individual patients. Common sense need not apply (and it doesn't, either).

peter hoh said...

Irene, it's terrific news that Avastin worked for you. Here's to many more years.

We need to keep an incentive for the development of new drugs like this. There are tremendous costs involved.

Yes, if the market gets to work as a market should, costs come down when something is widely adopted.

But the health care market is not a free market. There are all sorts of things that stand in the way of market forces being allowed to do what market forces do best.

JAL said...

@ sunsong If you believe that healthcare ought to be rationed because it is so expensive - what was wrong with insurance companies doing the rationing?

Interesting question, sun.

And what exactly will change? As more people end up being covered by Obamacare as companies bail on coverage due to the costs and penalties, it won't just be OLD people.

Watch the quality drop .. . . .

They say it is to make things "fair?" (Except for Berwick and all the elite hypocrites.) No. It is to give the government more control over we peons who are too dense to know how to make choices. (Whatever happen to that big liberal "choice" meme?)

As others have pointed out, good, effective treatments are not "new" by the time they get to the general marketplace.

But with no marketplace to get to --

AJ Lynch said...

It's like Obama can't catch a break. Bad news on top of bad news.

AJ Lynch said...

Peter Hoh:

Liberals seems to think we can't spend enough on our crappy public schools so why are you griping about a drug that can save lives?

How about if I asked you- how much money per student should we spend on k-12 public school education? After a certain amount, should we ask the parents to chip in and write us a check?

JAL said...

You know Peter, insurance companies already set limits. It's in the contract.

But there are negotiable points in that kind of a relationship. And choices.

When the government owns it all there will be no negotiating room, no other choices.

Why are you always arguing from the extreme point. (How many blocks from ground zero is ok? How much money is too much?)

It doesn't seem like you are looking for answers as much as trying to force black and white thinking onto a complex issue.

Milwaukee said...

Peter Hoh:
"But the health care market is not a free market. There are all sorts of things that stand in the way of market forces being allowed to do what market forces do best."
Like Government intervention. Allowing advertising to be take deductible encourages advertising. And Pharmaceuticals spend tons on advertising. Having medical schools put a choke hold on the numbers of new doctors is a problem. We allow young men in combat to do a great deal as medics on the battlefield. Why haven't we ramped up Nurse Practitioners and have clinics in stores. Have them spend time in a rotation with doctors, so they are continually up grading their ability to recognize what they can't treat, and let them treat what they can.

How about taxing health care as a benefit, which could then separate health care from employment, so that people wouldn't lose their health care when they lost their job? How health insurance is regulated in the tax code has shaped how health services have been delivered. Then there could be health care unemployment insurance: once you lose your job, the health care unemployment insurance would pay those premiums for a period of time.

None of this was meant as sarcasm.

reader_iam said...

Really, both types of coverages deal in horseshit. Both are largely involved in sucking up bucks from people who are light users for the benefit of people who are heavy users but in surprising numbers who either haven't, or won't now, or both (but mostly the two former) put up with bucks being sucked up from them.

Both types. Both!

traditionalguy said...

The day Nancy Pelosi and her husband return their eternal free government health care that contains no death Panels is the day that the Trillion dollar cuts to medicare that designed to end most end of life expenses will suddenly stop. The Fidel Castros and the Obamas and Pelosis will never face the cut off of their benefits, although the prepaid medicare contributions made over lifetimes of many hard worker have been Madoff with by their con games.

lucid said...

peter hoh:

We WERE paying for our health care via private health insurance until Obama and Pelosi seized our own health care dollars and re-distributed them to others.

Howard Dean has admitted tha tthe real function of ObamaCare is income re-distribution.

I can't wait to vote against every Democrat on the ballot.

JorgXMcKie said...

I'm not really sure, now, what peter hoh is protesting against.

Basically, the people who pushed Obamacare promised that everyone would get all the medical care they wanted/needed and it wouldn't cost any more than now. Plus you could keep your current plan and doctor as long as you want as some President or other claimed.

The opponents who claimed that was about as realistic as unicorns and fairy dust were pretty much being ignored until Sarah Palin said, "death panels" as a shorthand for the government, not individuals or their insurance companies, would have panels or groups who decided what 'care' got paid for, and thus would sooner or later decide who died when. The Obama care supporters hooted and tossed feces.

Turns out, Palin was right.

Look. The problem for most of us is that not only do you at least have some choice of what kind of insurance coverage to have, we can argue with the insurance provider, sometimes successfully, when they don't want to pay. Does anyone really believe that the Average Joe can do that with a government panel?

Look. The powerful will insulate themselves, the way they always have. [Like with secret hospitals for politicians in Ottawa.]

And does anyone remember the hue-and-cry from the Lefties when women wanted autologous bone marrow transplants to try to cure breast cancer [when there was zero scientific basis for believing it might work] and some insurance companies were forced by the courts to pay $1M for treatment without a chance in hell that it would work? Evidently they only care about cost when it is the government spending your money.

Milwaukee said...

Ann: Didn't we just have a brouhaha about things taken out of context. Your quote of me was "Nowhere in the Health Care Reform Act does the expression appear. Scare mongers."

But my paragraph was "Oh common on. "Death Panel" is an expression that hockey mom from Wa, from Wa, from up north made up. Geewilickers. Nowhere in the Health Care Reform Act does the expression appear. Scare mongers. (That was meant to be sarcastic.)"

You a friend of Breitbart or something? Wait, he didn't do that. Maybe you should be friends with him. (That wasn't meant to be sarcasm. We should all be friends with Breitbart. He seems like a man with a mission.)

lucid said...

The more I read what Hoh is arguing, the more furious I get.

GET OUT OF MY HEALTH CARE SPENDING DECISONS!!!

I WILL DECIDE VIA MY PURCHASE OF PRIVATE INSURANCE HOW TO ALLOCATE MY RESOURCES.

YOU WANT THE GOVERNMENT TO DECIDE HOW I CAN ALLOCATE MY OWN RESOURCES. YOU WANT TO TAKE MY RESOURCES AND GIVE THEM TO SOMEONE ELSE--WHICH MEANS GIVING ME LESS.

YOU ARE ROBBING ME OF MY OWN HEALTH AND GIVING MY HEALTH TO SOMEONE ELSE.

STOP, THIEF.

reader_iam said...

Also, both deal in massive skimmings off, most often and not coincidentally for the benefit of those most vehemently and aggressively defending one over the other, which ever one or other those may be.

But, in truth, both are dealing in horseshit.

Matt said...

I thought you guys were opposed to Medicare? Why do you suddenly care about this? Isn't is a "waste" of your precious tax payer dollars?

lucid said...

@c3:

You're an idiot.

No drug works a cure with advanced stage metastatic cancer. The point of provenge is that it provides a way of also treating less advanced forms of prostate cancer, with a probable much higher level of effectiveness.

lucid said...

The ethics of ObamaCare is the same as stealing organs to sell to someone else. In both cases, you are robbing one person's health and giving it to someone else.

bagoh20 said...

Congrats Irene.

I start a similar drug (Nexavar) this week.. I have no current sign of cancer, but we expect it. Most of the expensive drugs don't really cost those kinds of dollars to the insurance companies and they usually go generic pretty quickly. I've had a lot of drug therapies and nearly all of them are now generic or will be soon. They cost me maybe $20/ month and they are life saving. That's called private health care. It works, and we are throwing it out, because 52% of us are suckers.

Irene said...

Good luck, bagoh20. Your observation is on target.

I often think about your elegant "Gratitude" post when things are blue.

Ritmo Brasileiro said...

Big news recently among those of us not ignorant of medicine regarding ODAC's recent ruling on Avastin re: its lack of efficacy versus toxicity for breast cancer.

And them's no small potatoes. Most chemotherapy is highly toxic and extends life at most by a few months. But I'm sure it was all politics behind the decision, right?

So good going, Altie! I knew you could half-ass together some politicized bullshit to scaremonger with. In the meantime, find me one physician who will be anywhere near as willing to prescribe something once FDA takes steps as dramatic with this. It happens all the time. Of course, you won't. And you can't. But you're not an oncologist or a physician so you don't have to worry about disseminating half-truths and outright falsehoods to your vaunted public.

Which I guess gives you full license to bitch about Medicare not covering homeopathy, as well. Where's the controversial Althouse post about that one?

More dishonest bullshit here than on any other blog.

reader_iam said...

You're welcome, bagoh20.

reader_iam said...

Also, you're welcome, Medicare beneficiaries.

Ritmo Brasileiro said...

The FDA endorsed Avastin for advanced breast cancer in 2008 despite divided opinion about its usefulness for that purpose. Only one study had found that the drug appeared to delay an advanced breast tumor from growing by about five months. It remained unclear whether patients lived longer or experienced an improved quality of life.

But the FDA approved Avastin under a special program designed to make new treatments available as quickly as possible, with the caveat that pharmaceutical companies conduct follow-up studies validating their drug's effectiveness. The agency has been criticized for not adequately reviewing such approvals. Only one of at least 90 drugs that have received accelerated approval has been pulled.

An FDA advisory committee voted 12 to 1 on July 20 to withdraw Avastin's authorization for advanced breast cancer based on two new studies that the advisers concluded had not shown that the drug extends life. Not only that, the committee concluded that the studies indicated the drug slowed tumor growth for even less time -- perhaps as little as about a month. "The vast majority opinion of the committee was that the drug was not doing very much, and what it was doing was more than offset by the negative," said Wyndham Wilson of the National Cancer Institute, who chaired the committee. Avastin can cause a variety of potentially serious side effects, including blood clots, bleeding and heart failure. "In our best judgment, we did not feel this drug was safe to give relative to its benefits," Wilson said.

The recommendation has been praised by many cancer experts and by advocates for breast cancer patients.

"The FDA should never have approved Avastin for breast cancer to begin with," said Fran Visco of the National Breast Cancer Coalition. "We don't see evidence of benefit, but we do see evidence of harm."


Out with you, Fran! And put Althouse in charge at FDA! She should be the citizen-commissioner at large!

Matt said...

BTW did some research and this story is incorrect.

First the story you link says:
an FDA-approved anti-cancer therapy MAY not be covered by Medicare.
'May not' and 'Won't be' are two very different things.

Second CMS is simply reviewing Provenge to set their national coverage policy. The drug Provenge was only approved by the FDA in April so the Medicare providers are trying to figure out coverage guildelines. Most of the Medicare Regional centers have said they will work with Provenge providers to carry it.

Read up on it. A simple Google search will do it.

amba said...

I've just been researching cancer research. On average, Avastin has been a very expensive disappointment. It blocks one pathway to angiogenesis, the way tumors stimulate the growth of blood vessels to supply them with nutrients, but there are something like twelve other pathways, and some cancers can mutate to avail themselves of another. Avastin is enormously expensive and on average, combined with standard chemo, prolongs life by a handful of months. Very glad Irene got it and that it worked so well for her.

Ritmo Brasileiro said...

Full Disclosure:

The controversy with bevacizumab pertains to its lack of efficacy in treating breast cancer, that's where the FDA decision lies, and that's likely where any changes in Medicare reimbursement would lie as a result.

Of course, the patient quoted in the blog post is referring to ovarian cancer, which is a different ball of wax.

Full disclosure: The breast and the ovary are actually, get this, TWO DIFFERENT ORGANS. The treatments used on cancers at those primary sites may actually, get this, NOT WORK EQUALLY WELL.

But of course, why should I bother explaining this. A blogger had a chicken little story to report and that's what counts. Perhaps they need to tell those fools at FDA to get out of the way, because someone who might not be able to tell a breast from an ovary has some controversy to peddle.

Good night.

c3 said...

Lucid;

No drug works a cure with advanced stage metastatic cancer. The point of provenge is that it provides a way of also treating less advanced forms of prostate cancer, with a probable much higher level of effectiveness.

from the products website:

PROVENGE® (sipuleucel-T) is approved by the FDA as an autologous cellular immunotherapy for the treatment of asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) prostate cancer.

So it is indicated in metastatic prostate cancer.

Stage IV prostate cancer: Cancer cells have spread (metastasized) to lymph nodes (near or far from the prostate gland) or to organs and tissues far away from the prostate such as the bone, liver, or lungs.

There are only four stages to prostate cancer

c3 said...

If you believe that "rationing" is withholding resources for some treatments and allowing resources for others, and if you believe we have limited resources (a basic concept in economics) then we have and will continue to have rationing.

Personally, I'd like to have as much control over the care that is "rationed" to me. But of course that desire comes with a cost; the more I pay, the more I control.

Ritmo Brasileiro said...

I don't think this post is nearly sensational enough.

For context, we should trot out the ole' thalidomide scandal.

Remember that one? FDA was fascist enough to deprive pregnant women a very effective sedative that was all the rage elsewhere.

Nevermind the fact that their kids came out with flippers instead of hands and feet.

Where does Obama and his arrogance end? Obviously if a woman wants to give birth to someone without limbs, just because it helps her sleep better, that is her God-given right as an American citizen and no one can tell me otherwise or I will call on the Tea Parties to exercise their second amendment rights and overthrow this communist/fascist/racist/socialist tyrannical regime ASAP.

Congratulations on going the Glenn Beck route on public health, Ms. Althouse. Very impressive use of propaganda and paranoia.

Matthew said...

Simple solution:

Expensive cancer drug for everyone, Welfare for no one.

amba said...

Economies of scale together with rapid technological advances would likely quickly bring that cost down dramatically.

Huh? Not as long as a drug is under patent protection. What's that, seven years?

Ritmo Brasileiro said...

20 years, but that also applies to the time spent in trials.

Look. If you guys want to ask someone who knows what he's talking about regarding any of this stuff, I'm right here.

But I'm afraid I'll also have to be honest with you and not bullshit and half-ass information that's very important to FDA, any practitioner, patient or clinical researcher just so that I can make hay of Professor Mooseburger's run at the White House.

amba said...

More on cancer research: since Nixon declared "war on cancer" and Congress passed the National Cancer Act in 1971, we've spent about $200 billion public and private dollars. The death rate has gone down about 1 percent per year since 1991; that is, the number of annual U.S. cancer deaths has stayed steady at about 560,000 while the population has increased (and aged). That decline in the death rate has saved or prolonged an estimated 650,000 lives in 20 years. Most of the decline is due to prevention -- namely, people quitting smoking (over half of American men smoked in 1970, one-fifth do now) -- and to early detection.

If more of that 200 billion had been spent on scientifically studying what (besides quitting smoking) actually works to prevent cancer, and on devising much earlier and more precise forms of detection, many, many more lives would have been saved. The "we have to understand how cancer works and then we can cure it" track on which so much money was lavished has indeed led to much more understanding of cancer; unfortunately what scientists have come to understand is that cancer is too complex to be understood (anytime soon, if ever).

Canary Foundation, headed by Don Listwin, the former #2 at Cisco Systems (whose mother died of ovarian cancer), is spearheading a crash collaborative effort -- open source, รก la IT -- to improve early detection.

By the way, the epidemic of prostate cancer we're in the midst of is likely due to early and prolonged exposure to the large amounts of estrogen-mimicking synthetic chemicals released into the environment.

Chase said...

Really Ritmo? You're blowing a gasket . . . why again?

Some people are educated beyond their intelligence.

The issue can be exagerrated in this post, yes, but the bigger point is this:

More and more and more decisions about who gets the necessary treatments - especially high success rate/High cost - will be made on the aging population by government bureaucrats. There is no way around it now. Please do not be one of the educated yet stupid and disingenous who deny it is coming; those idiots will be shown to be the evil liars they always were in just the very near future.

It didn't have to be this way. But it cannot be anything else after Obama care happened. Bookmark this email. It is going to be at the top of the "I told you so's".

Charlie Martin said...

How dare she be so selfish to want to live longer when the government has told her ity's not worth the money?

reader_iam said...

IMO, the political fight over health-care issues framed as end-of-life issues is now (as opposed to other times) more about:

1) start-of-life issues

and

2) retention and/or allocation of wealth issues.

FWIW.

But I do think that explains a whole lot of things and stuff (apart from the personally anecdotal, which is something else again).

nikrok1 said...

Let Sullivan's weeping and gnashing begin. Palin was SPOT ON.

Ritmo Brasileiro said...

Chase:

Medicare doesn't cover treatments that aren't FDA approved. Never did. Doesn't matter which regime. Pre-HCR or post-HCR. It just doesn't happen, it won't happen and neither Democrats nor Republicans can make it happen.

I fail to see how that is controversial.

Now, Ms. Althouse could have bothered to do enough basic research to have figured that much out, which might have brought her to the easily available, widely publicized and very recent FDA story. But she didn't.

We can debate the HCR policies all you want. I've never had a problem with that. Never will. Nor do I have my mind made up. I think a couple of the Republican ideas were great contributions and have always been partial to private, individual approaches myself. HSAs have a lot of merit to them, at least in theory.

But when someone titles a post "Death panel." and links to a story on reimbursement without any of that context, I'm finding myself incensed.

Why, you ask? Because some types of misinformation are so problematic that they become a public health concern in their own right.

I can't do much about foreign shops that sell fake Viagra. But I know that this is a somewhat influential blog and popular with many on the right and in the middle. Not that popular, but popular enough.

For Ms. Althouse to scare people with implied falsehoods related to the basic regulation and reimbursement of medical treatment in America is unconscionable.

I was prepared to just accept the ridiculous phrase "death panels" and be done with it, as I have since that golden nugget was first mined. But this is incredibly irresponsible. Look at the stories on bevacizumab in re: FDA. It's approved for five indications and since the other four haven't been called into question it will likely still be available and possible to use for off-label indications (not that oncologists would be so reckless or experimental to do so), so this malarkey about the government killing us off by not paying for something out of expediency is not only the biggest crock of hogwash I've heard of in a long time -- if it gets picked up by other right-wing outlets it might seriously impact the right's credibility, esp. the tea parties.

I don't have a problem with that. But if they had to make martyrs out of themselves, it's remarkable that they've chosen to do it on the altar of dispensing irresponsible misinformation to the public like this.

Cancer is a life or death thing. I take it seriously. So to with health information related to it. I apologize for being emotional, but I find this sort of thing quite outrageous. It's not just about blog hits for me but a basic sense of decency and responsibility.

Hope this makes sense. Thanks for giving me the opportunity to clarify.

amba said...

Okay, get it together, Republican and indy voters. Take back Congress and repeal the damn thing!

reader_iam said...

Irene, I am happy for you. But the truth is, you got the medical treatment you needed because tons of others who are very light to light users of medical services, much less health insurance, pay in a lot of money every month, every year, for private health insurance. (And also are taxed for public insurance.) Those excess dollars (in terms of what those folks get in return), like it or not, mean you, too, are being subsidized by others.

The whole system is whacked.

reader_iam said...

Isn't it?

Ritmo Brasileiro said...

Jesus amba. After all this you're still not getting that the bill has nothing to do with not reimbursing unapproved treatments?

See what I mean, Chase? And amba seems to know at least enough or be educated at least enough to provide relatively insightful information in the other posts. Why is she not being called out for being over-educated or whatever?

I have worked in this business for nearly ten years, in various capacities. Repeat after me: Reimbursement of non-approved treatments is not a political issue.

There. Now take a deep breath and take solace in the fact that no amount of funding and marketing should convince the government to reimburse an item (a hazardous item) that doesn't work. It's not been the case before and it's not expected now. Except in Tea Party Land.

reader_iam said...

I don't happen to think that nationalizing medical care under the aegis of the federal government is the answer, by the way. I oppose that, full stop.

Youngblood said...

Obama said this was coming in his New York Times back in April of 2009.

THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

So how do you — how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

----

The Obamabots will point out that the President said that it won't be determinative, but how can it not be determinative? Either treatments are paid for or they're not.

If people start raising a fuss because the FDA approves drugs that the government won't pay for, the government can always just change the rules. I mean, the FDA is a government agency after all, right?

It wouldn't be that hard to just deny NDA's for treatments that are not likely to be cost effective from the government's point of view (keeping them from being approved) are significantly increasing the testing period for such drugs to discourage their development.

reader_iam said...

If only because I know full well that the federal government is incapable of putting certain targeted monies into specific buckets for use only for the specific purposes for which they were collected and, supposedly, set aside and saved--much less let all that principle accrue interest.

amba said...

After all this you're still not getting that the bill has nothing to do with not reimbursing unapproved treatments?

No, I get that. I oppose it for other reasons.

reader_iam said...

much less let all that principle accrue interest.

That should be **principal**, of course, not "principle," of course--though, as Freudian slips go, it's not a bad one. : )

amba said...

reader, if I understood correctly, Irene started out getting Avastin in a double-blind clinical trial -- so she didn't know till recently if she was getting that or placebo. Recently she learned she was getting the drug. Did her insurance then continue to pay for it for her? That wasn't clear to me.

Ritmo Brasileiro said...

While my impression is that the Bush administration was able to politicize FDA to the point of blocking approval of morning-after pills, I'd be hard pressed to see ODAC achieving that degree of politicization. You can fret about it, fantasize about it, scaremonger about it. But for the members of the Oncology Drugs Advisory Committee to risk their reputations in such a political way is not a prospect that anyone in the medical profession takes seriously. Especially when the evidence is there.

Has anyone here actually bothered to review the studies that FDA cited?

Man, is our republic in bad shape.

peter hoh said...

Milwaukee @11:01, those are all great questions. It may come as a shock to many here, but I'm not a big liberal on health care.

amba said...

And, Ritmo, you're right about the misleading sensationalism of heading a post on THIS subject "death panels."

Ritmo Brasileiro said...

Thank you.

Ritmo Brasileiro said...

I'm not completely sure, but it's probably more likely that you would get coverage for an IND (investigational new drug) under Medicare than with a private insurer.

Randy said...

Until now, I had no idea that so many people believe that a program such as Medicare should never say no to any drug or procedure no matter how infinitesimal the likelihood of its efficacy.

Randy said...

I'm not completely sure, but it's probably more likely that you would get coverage for an IND (investigational new drug) under Medicare than with a private insurer.

It is extremely unlikely in either case, but you'll have a hard time convincing anyone who has not experienced a routine denial that that is true. Most people are blissfully unaware of the exclusions and limitations of their policies and accompanying drug formularies.

ic said...

ph: If the government is footing the bill,

The god damned govt is not footing the bill, the govt forces the taxpayers to foot the bill.

The taxpayers can buy their drugs, but can't afford to because a huge chunk of their money is confiscated every year to fund the "govt" projects which benefit the connected, e.g. George Soros who in turn will "contribute" to campaigns.

The US govt. is the most corrupt govt. The only thing they are good at is using euphemisms. Grafts is "campaign contributions", pay back sugar daddies with taxpayers' money is "earmark". US taxpayers are fools.

peter hoh said...

Lucid @ 11:07, try reading what I wrote a little more carefully.

I am arguing that you should have more control of your health care dollars.

People should not be using other people's money on ineffective, expensive treatments.

How is that an argument that your money should be redistributed?

See Giles @ 10:03.

Anyone who thought that the government could run healthcare without some sort of limits is a fool. If you want to call that rationing, fine.

The other option is runaway spending.

We've tried that.

The bill is coming due.

Randy said...

reader, if I understood correctly, Irene started out getting Avastin in a double-blind clinical trial -- so she didn't know till recently if she was getting that or placebo. Recently she learned she was getting the drug. Did her insurance then continue to pay for it for her? That wasn't clear to me.

As a general rule, insurers are not involved in such studies, so I think the question should be, "Did the insurer BEGIN to pay for the medication once the study ended or did the trial sponsor continue to supply the drug?"

reader_iam said...

People should not be using other people's money on ineffective, expensive treatments.

That's already embedded in the system. Correction, both systems. Private and public.

How is that an argument that your money should be redistributed?

First, let's define "redistributed."

peter hoh said...

ic, if you insist, then please substitute "the taxpayers" for "the government" in every one of my posts.*

It means the same thing.

*except perhaps this one:

If the taxpayers are footing the bill, any effort to curtail spending is going to be perceived as "the government" telling people to drop dead.

peter hoh said...

Randy: Until now, I had no idea that so many people believe that a program such as Medicare should never say no to any drug or procedure no matter how infinitesimal the likelihood of its efficacy.

Hee, hee.

You mean Congress can't increase Medicare spending and decrease spending at the same time?

peter hoh said...

Reader, perhaps you can tell me how Lucid thinks that I want the government to make his or her health care decisions.

I am completely baffled.

Maybe if I prefaced everything I wrote with "Obama bad, Palin good" there wouldn't be this confusion.

Youngblood said...

Ritmo,

I'm not talking about ODAC. I'm talking about Congress.

The FDA is a Federal Agency. How do you think that the FDA's policies changed after the Thalidomide tragedy? Through legislation.

That's how the system works.

If we move toward a system in which the government is forced to determine what to pay for and what not to pay for, then legislators will have a vested interest in keeping costs down.

If they have a vested interest in keeping costs down, then they can craft new legislation or amendments to the Federal Food, Drug, and Cosmetic Act to help them do that.

ODAC doesn't control the FDA, Congress does. It is a political construct that is inherently politicized. If you give Congress an incentive to meddle, then it will do just that.

Randy said...

You mean Congress can't increase Medicare spending and decrease spending at the same time?

Peter: LOL! Most people are content to believe the ongoing fiction that Medicare costs are being contained without sacrificing anything. It is easy to pretend that the annual congressional over-ride of physician reimbursement reductions isn't happening because Congress almost always says, "Alright, you guys! This is it! Never again! And this time, we mean it!" Of course, they don't because they want to be re-elected and even the ones in the gerrymandered seats might lose if they do.

peter hoh said...
This comment has been removed by the author.
peter hoh said...

I'm a bad writer.

Here's what I should have written:

There's no way to control health care spending. We're screwed.

reader_iam said...

Peter Hoh: I could hazard a guess, but it wouldn't help you and most likely it would accrue to the contrary. : )

I'm way more persona non grata than you, Peter. However, I do wish you this: "Good luck!"

AC245 said...

Randy: Until now, I had no idea that so many people believe that a program such as Medicare should never say no to any drug or procedure no matter how infinitesimal the likelihood of its efficacy.

peter hoh: Hee, hee.


You twits act like it's some great gotcha that people expect a government program to deliver on its promises, to live up to what it was sold as, after they've been forced to pay into it for their entire lives.

Can either of you identify anyone here who is critical of the M/M system who wouldn't be happy to opt out of it and handle their own health care decisions on the the condition that they got back all the money they've paid into M/M plus interest?

(And you're down to giggling over tired talking points, now, peter. JAL really had your number in her 8/15/10 10:59 PM comment.)

Randy said...

There's no way to control health care spending. We're screwed.

Yep!

Youngblood said...

Here's a sobering thought for everybody, no matter what side of the health care debate you're on:

In the interview I cited, Obama was basically correct when he said that the lion's share of our healthcare costs represent care for the chronically ill and those at the end of their lives.

We've gotten all of the easy and cheap stuff out of the way.

Barring some sort of massive technological leap, a lot of the drugs and treatments that we'll be seeing in the future will provide relatively small gains at high cost. So the costs are going to keep going up.

Given that the demographic bulge of the Baby Boom is now entering the end of its life, this problem will become increasingly urgent. A whole lot of new senior citizens are going to be added to the Medicare rolls over the next 20 years or so. They will live longer than prior generations so they'll be on the rolls longer, but that life extension will come at a very high price.

Whether the current healthcare reform law eventually blossoms into something much more like socialized medicine or it's repealed, Medicare is a reality, the high cost of keeping people alive into very old age is a reality, and the vast size of the Baby Boom generation is a reality.

No matter what happens, we are on a collision course with something sucktastic that nobody wants to talk about just yet.

reader_iam said...

Can we all just agree that for the money put in certain investments--that is to say, bets on certain risks--some get a whole lot more than what they put in (more than they'll ever put in, by huge factors) and most of us get a whole lot less?

Randy said...

Afraid you are right, Youngblood.

Randy said...

a government program to deliver on its promises, to live up to what it was sold as, after they've been forced to pay into it for their entire lives.

I missed the ads promising unlimited care for anything and everything for as long as we live. I do recall, however, endless warnings about the health of the program over the past 30+ years, and repeated well-publicized efforts to contain skyrocketing costs.

As to your question, you and anyone else who claims they'd take that option will never have the opportunity to actually do so. Thus, talk like yours is cheap.

Finally, I haven't a clue whose talking points we're supposed to be following, but AFAIK, neither Peter nor I qualify as champions of the recent health care bill.

reader_iam said...

AC245:

You twits

Twit you.

wv: quiti

Heh. OK. If you say so.

AC245 said...

I missed the ads promising unlimited care for anything and everything for as long as we live.

I guess you can find your straw ads in the same place as your earlier straw people who believe that a program such as Medicare should never say no to any drug or procedure no matter how infinitesimal the likelihood of its efficacy.

Wouldn't it be easier and more productive to the conversation if you responded to the things that people actually say, rather than constantly making things up?

Methadras said...

peter hoh said...

Trad guy, if I came up with a treatment that cost $5,000,000 and extended the life of a colon cancer patient by two months, do you think the government should pay for it?


Doesn't matter. The government has stepped into the game by saying they will. It's on them now. They were told not to do it with scenarios like the one you present now, but they bullied their way through it regardless of public outcry, now it's on their heads and if they do make decisions to stop or not pay for treatments even though they claim pre-existing conditions will be pulled under the tent of coverage as well, then the death panel claimers were right all along.

Methadras said...

peter hoh said...

This is why I think that people ought to be paying for a larger share of their medical coverage.


That's what health insurance coverage is for. Especially from private insurers.

If the government is footing the bill, any effort to curtail spending is the government telling people to drop dead.

Again, this would prove that death panels were accurately described by people against health care legislation.

And if the government commits itself to footing the bill, no matter what the cost, we're going to see more drugs like Astavin, which cost something like $50,000 to $100,000 for a course of treatment.

Which is another reason why conservatives where against this legislation because the government takeover is tantamount to monopolistic treatment pricing. If these treatments are available and yet artificially expensive because they end up being cost plus pricing to the government, then government pays a premium. Otherwise private insurance premiums would have covered these costs based on plans. Now there is only one plan. The government plan.

reader_iam said...

20 bucks a month?

Sounds to me like something's being subsidized, somewhere, somehow, by someone.

HDHouse said...

Hmmmm 125 comments and only a few of them factual. You all might just want to look at the article and the posts that follow..one in particular that notes "under review" among other things ... and this is a normal step in cost determination of any cancer drug or any new drug for that matter.

You people are soooo easy, no wonder Faux Noise types prey on you so much.

Patm said...

And yet....look what Nancy Pelosi did:

http://www.dallasnews.com/sharedcontent/dws/news/politics/state/stories/DN-texwatch_15nat.ART.State.Bulldog.365449b.html

edutcher said...

Irene said...

If Avastin is what stands between you and death, then yes, "Death Panel" is an "appropriate statement" and yes, it is appropriate to cause alarm.

Full disclosure. I have advanced ovarian cancer. Hello friends and relatives.

The statistics for my stage of ovarian cancer (Stage IIIc) project an 18% survival rate two years after diagnosis.

I took part in a clinical trial for Avastin. My provider recently revealed to me that I received the test drug.

I am approaching that two-year mark of initial diagnosis, and so far, I am doing well. I attribute that good result to Avastin, which prevents the regeneration of cancer cells. Yeah, I had some lousy side effects, but it seems to have worked.

Thank you, and good night, Irene.


No, not yet and for many years to come. The Blonde and I send you all our best wishes that you will prevail in your fight.

Lockestep said...

This is not a zero sum game. A 50K treatment will replace some other therapy which has associated costs. Modern chemo drugs can run 10K for a course of treament.
Further, if a therapy extends life for X number of years, then there are Y tax dollars (usually) generated by the patient, as well as the economic effect of the patient's productivity.
Since we are talking about a societal cost, we need to also consider the societal benefit.

reader_iam said...

Since we are talking about a societal cost, we need to also consider the societal benefit.

And therein down the garden path we go ...

Cedarford said...

Michael McNeil said...
if I came up with a treatment that cost $5,000,000 and extended the life of a colon cancer patient by two months, do you think the government should pay for it?

Maybe. Economies of scale together with rapid technological advances would likely quickly bring that cost down dramatically.

===================
Perhaps no belief has been more ruinous to taxpayers and planners than the magic cost-lowering power if "high technology".

If computer memory prices drop..then OF COURSE!!...the price of of military helicopters, small planes, heart drugs, hospital day costs, and teachers must also drop as miracle technology blesses those endeavors and us!!!

If nothing else has hit Americans square in the face as a ruinuous simple belief (along with free trade as a jobs creator, supply side creates more government revenue).....it is the sorry 40 year record of "high tech!" as applied to medical care costs, teaching, military being any kind of a cost saver.

We are now in reality check time. Our wealth has bled away from free trade and military overcommitment. Trillion dollar deficits, states going bankrupt on "high tech teaching Masters graduate's" pay and all the pricey factotums at all levels of government applying high tech and their college degrees to tax and regulate us better.

We can't afford it.

So something has got to give.

1. If a "superteacher" with a high tech classroom we "invest" 90,000 extra per year in salary and classroom tech can raise the SAT math score of 75 unmotivated low IQ blacks from an average of 377 to 392.....is it worth it?

2. If a miracle high tech hospital using eye-poppingly priced experimental drugs can keep a 87 year old senile woman with congestive heart failure and stage 3 colon cancer alive for 3 more months of LIFE! PRECIOUS LIFE!! - is the 630,000 bill to taxpayers worth it??

Options are few. China won't loan us the money to keep going forever..eventually taxes have to go up to pay for superteachers, billion dollar high tech helos, 400,000 a course of treatment lung cancer drug.
Or we do the Palin route - claim we want to not create 2 Americas of school and heathcare for two classes of citizens, we need MORE tax cuts and free trade, and government has NO business controlling costs - certainly not in medicine where "DEATH PANELS" could deny a 400K drug that might give some hillbilly 2 more months of life before Jesus comes.

Lockestep said...

We are already down that path, reader. Unless we can somehow elect a government interested in divesting assets, we are doomed to panels making utilitarian calculations on what to pay for and what to deny. And those panels will be comprised of people who have the means to override the denial in the case of themselves and their family, by buying their way in to alternatives denied the masses.
Same as it ever was, though - instead of funding a monastic order to pray them out of purgatory, the elite jet to clinics to buy a little more life/.

Pogo said...

"We CAN spend a lot of money on X, Y, and Z. That doesn't mean we should."

I hate when people speak with the royal 'we', or the communal 'we' about what ought to be personal decisions.

But the gummint took over health care and now what I want no longer matters.
What the politicians want matters, and what they want is money and power. Once they have sucked me dry as one of the gummint milking cows and I get sick, what I was promised in this bullshit national program will be denied.

So don't give me this 'we' shit. There is no 'we'. There's me, there's you, and there's a cabal of gummint bastards in control of my life. And they can all go to hell.




Just wait for the first national physician strike. It's coming, and it's power will shock you.

Cedarford said...

Pogo - "Just wait for the first national physician strike. It's coming, and it's power will shock you."

Just wait then for the hammer to drop following such a strike - that physicians in the US are hugely overpaind compared to their other advanced nations counterparts, that doctor-lobby control over med school supply, state licensing, and H1-B visas adds costs.

==================
An age of limits is facing America, and the days of judges mandating new costs will soon be over, even if at gunpoint. We can't pretend anymore that we can have tax cuts AND spend a trillion and a half on wars for FREEDOM LOVERS well away from our vital interests. Or a judge can say free food, free medical care, and free school for illegals, spawn of illegals, and chain migration of 9 million elderly parents of foreigners to add to our SS and medicare systems who never chipped into it.
We can't pretend anymore that magic money can be found at no cost to any American keep granny alive on the public teat at 300K for one more month of coma.....and not have to actually start charging taxpayers and admit there is no such thing as free Saudi or Chinese money.

Paul Zrimsek said...

That's bad about the Avastin, but you should know that Ahoyin, Arrrrin, and Shivermetimbersin are almost as effective and they've gone generic.

Pogo said...

"Just wait then for the hammer to drop following such a strike "

ha ha ha.
Just like it 'dropped' following strikes in Canada and England?

All state-industry rules end up being written and controlled by the industry. Every time.

The only haircut will be to patients, who will get less time with doctors, lesser trained 'providers', longer waits, fewer options, restricted formularies, and unelected and unaccountable death panels making decisions for them.

But keep that dream alive, man.
Hilarious.

Pogo said...

Cedarford: the hammer will drop just like it did on the teacher's unions, right? And nurses unions, right? And those fireman and police unions in California and elsewhere: completely ineffective, right?

MeTooThenMail said...

Late to this thread as usual.

Just returned from a Parkinson's disease conference.

The mood was very dour.

Everyone talked about the restriction of access to testing, therapeutics, reimbursement for services.

It is not "socialized medicine" that people fear or loathe, it's "federalized medicine."

That, and the states are basket cases.

The doctors (and hospitals) in Illinois are owed $2Billion dollars by the state with little hope of every seeing the money.

My staff, for example, spends almost 5 out of every 8 hours calling insurance adjusters for pre-authorization for tests or treatment, everything from MRI's to drugs. And note, most of my patients are CMS patients. I've got news for everyone, the rationing is in full effect.

As to the US doctors' lobby..WTF?

And who or what is that, the AMA? They represent less than 20% of all doctors and many or most of them are in academia, residents, students, and are not representative of any of the specialities.

As for US docs "controlling" visas... are you on crack? Residents are getting sent back to India (mostly) every year because they can't stay even though many of them would get jobs here in the US, and they would work where US born and trained docs wouldn't go.

As for the fact the US docs are "overpaid", there is a premium for innovation, there is a high cost to US training not found elsewhere (I'm not aware of European, Chinese, Russian, or South American docs leaving their undergraduate programs and then medical school with over $200,000 debt), and in any case, you have little to worry about, older docs are leaving at record numbers in all fields, especially medical sub-specialities.

In neurology, with the already significant drop in reimbursement from the Jan. 1, 2010 CMS pay cut and with the estimated changes in Obamacare, it's estimated that some 30% or more of the nation's neurologists will retire or close their practices by 2012.

Good luck with that.

Lastly, as for chemotherapy, palliative, and end-of-life care, all of it expensive, none of it is curative, and all of it will be rationed extensively, so get used it.

That, and you will have less doctors to choose from and in many cases, in "fly-over" America, you may have little or none.

Enjoy!

MeTooThenMail said...
This comment has been removed by the author.
peter hoh said...

Methadras @ 2:59: you just gave some excellent reasons why true conservatives were opposed to the Medicare, Part D program.

As was I.

downtownlad said...

If a 64 year-old has this kind of cancer, Ann was doing everything in her power to make sure that the government didn't give that person a dime.

downtownlad said...

If an 18 year-old has HIV, and they don't have insurance, the government doesn't give them any money for the meds they would need to live.

Ann wants to keep it that way.

Ann supports death panels for gay people. Why?

admin said...

Peter Hoh:

You just dont get it.
Its not the state's/village's role to decide for the individual thier health care choices. If the state is not involved in it or funding it, then busybodies like you need not worry yourself, or wring your hands.

Repeal this piece of crap. Leave us alone!

A.W. said...

I think it is impossible to run medicine without a cost/benefit analysis of some kind. The problem with the government taking it over, however, is that they become the only game in town. If they don't provide it, you are SOL.

I hope Irene gets the medicine she needs one way or the other. And I think this story only highlights the problem with Obamacare has with the precedent of Roe v. Wade. If Roe is taken seriously at all as being about anything but judicial fiat, it is an extreme application of the rule that you have a right to control your medical destiny.

peter hoh said...

admin, show me where I have offered my support of the health care reform signed by President Obama.

Class factotum said...

Sort of related - bureaucrats are so efficient.

Paula Oertel, whose brain tumor disappeared for nine years while she was on an expensive drug and returned after she temporarily lost her insurance coverage, has died as a result of the tumor spreading through her brain.

The interruption of her Medicare coverage of the drug directly contributed to her death, contends her doctor, Mark Malkin, chief of neuro-oncology at Froedtert Hospital....

Due to a mix-up, Oertel temporarily lost her Medicare health coverage in November 2007 when she moved from Fond du Lac County to neighboring Winnebago County. The change in residence triggered a review of her Social Security disability status. In March, Oertel said she was told by Social Security personnel that they had notified her of the review. She said she never received a letter.

Oertel said she found out her Medicare coverage had been stopped when she went to a Walgreens in Oshkosh to pick up the interferon and was told her coverage had been canceled.


http://www.jsonline.com/features/health/100598969.html

carolynn said...

1) What is the efficacy of this new drug compared to other drugs on the market?

2) What is the price comparison?

3) What is it's efficacy on patients over 65?

I know we're talking about the right to choose our treatments on our own, but some treatments are approved (bone marrow transplants for breast cancer) may seem like miracles, but turn out not to be.

This post doesn't give me enough information.

Pogo said...

The seventies are back!

Obama is Carter, and health care is Logan's Run.

Pogo said...

"admin, show me where I have offered my support of the health care reform signed by President Obama."


peter hoh said: "We CAN spend a lot of money on X, Y, and Z.
That doesn't mean we should.
"



When you start talking "we" in health care, you are speaking in favor of state-run medical care.

lucid said...

@hoh:

you seem to be arguing that treatments like Avastin should not be covered; or you are arguing that "someone" has to make a decision about which expensive treatments will be available.

In the context of this thread, the "someone" appears to be the government.

Different health insurance policies can cover different degrees of treatment. For example, the excellent care that well-insured Americans get for prostate cancer is not available to citizens in England or in Canada.

How much American insurance policies cover use to depend on how much someone was willing and able to pay for the policy. Now it increasingly depends on what the governmnet mandates through ObamaCare's nomenklatura (many of whom ae themselves not subject to its restrictions).

I want the market to decide how health care dollars are spent. Many economists think that the rational choice many people would make is to spend up to a third of their income on health care.

ObamaCare---and you by the emphasis of your remarks on how we need policies that limits expenses--want "someone" to limit what I can spend on my health care (via a very good insurance policy) and re-distribute my health care spending to other people.

You are virtually taking the health of one of my organs and giving it to someone else.

I don't want that to happen.

Salamandyr said...

Class Factotum,

Similar thing happened to my aunt, though I don't have enough details to know exactly who decided to interrupt her meds.

Scott said...

These seem to be the fault lines:

Democrats believe health care is a right.

Republicans see health care as a service.

If health care is a right, a federal program must (a) give poor people the kind of health care that the middle class has access to now; and (b) make it hard for rich people to get health care that's better than the middle class--in the name of "social justice."

When you regulate access to goods and services that a person might otherwise acquire in a free market, that's rationing.

Regardless of the rhetorical dishonesty of the leftish, insurance companies do not engage in "rationing". They collude and price fix and create discount barriers, but that's not the same. In the United States (and unlike Canada or other single-payor countries), you can still get services and medicines within the country and outside the plan if you have the money.

Republicans, if they didn't have their heads up their butts, would empower people to care for themselves by addressing the insurance industry's anticompetitive practices (particularly discount barriers, which artificially inflate the cost of health care). Democrats would rather just ignore that and take it all over, since it appeases their fascist proclivities.

Any way you look at it, we're fucked.

bagoh20 said...

Reader,

I've paid insurance premiums my entire adult life and decades before ever needing to use it. That's how it works. Of course, the healthy subsidize the sick. So what, you got a better way? The problem with government involvement is efficiency, and stupidity. They have a long, nearly unbroken, history of managing things badly. It guarantees higher costs and poorer quality, with the terrible side effect of demotivating innovation. In short, everyone gets less than in a private system. It's not about subsidizing the sick, that's unavoidable in any system. You earn your subsidy by playing the game (paying for insurance). You agree to subsidize others in return for getting the same yourself if needed. It's perfectly fair and produces innovation rather than a bloated bureaucracy which will eventually suck up a huge portion of the benefits. It will become a jobs/ welfare program for the nonproductive, as every government program does.

MattJ said...

There are Medicare supplemental insurance plans, correct? If you want insurance coverage beyond what Medicare provides, you can go and get one of those plans. If you want a treatment that is not covered by your insurance, you can buy it with your own money.

Since Medicare is an insurance plan everyone is forced to enroll in, shouldn't we want it to be a basic, minimal plan? That would give people who want to pay for more coverage the ability to buy supplemental plans, while minimizing the demand on those who do not want to pay for more than basic insurance.

The problem seems to be that people want to have as minimal (read: cheap) coverage as possible until they need more, and then they want to get the treatment they need at someone else's expense.

former law student said...

Why not have Medicare take a look to see if a treatment is "reasonable and necessary"? Are people really taking a stand in favor of "unreasonable and unnecessary" treatment?

If a Chevy Cobalt will get you where you need to go, how can you demand your fellow Americans provide you an Escalade?

But treatments that have no cheaper alternative should automatically be considered reasonable and necessary.

former law student said...

Picture someone who wants that drug to live.

Picture someone who needs that drug to live.

former law student said...

Had I not picked an HMO when I started my last job, my lifetime health insurance benefit maximum would have been one million dollars. I wouldn't have had to die, just go into debt.

Dust Bunny Queen said...

Without reading all the posts about whether Medicare is good/bad or the drug is good/bad/ineffective etc.


The real point is: do we want government flunkies deciding these cruical medical decisions collectively for us, or do we want the medical professionals who are dealing with individuals deciding?

The other question is: whether you are covered by a private insurance plan or a government forced plan or Medicare that you have paid into and are also paying premiums on after retirement (Part B) why shouldn't there be a cap on coverage? And, what should it be?

Insurance companies currently have a lifetime cap, generally 1 to 5 million dollars. You choose which level you want by the premiums you decide to pay.

The Dems squealed to high heaven about the evil greedy companies.

NOW, when they find that they are actually going to be in charge.....they are squealing about the cost of unlimited coverage, as Obama promised, and are proposing caps.

What is the difference? The insurance company cap or the Government cap?

former law student said...

You do not get cheap treatments until someone has paid for the first, expensive treatment.

That won't be any health insurer, which uniformly deny coverage for "experimental" treatments.

Even worse, they don't realize that Socialist healthcare systems, like the NHS, or the Canadian system, have been free-loading off of US innovation.

The rest of the industrialized world should start paying their fair share.

When the government owns it all there will be no negotiating room, no other choices.

If only there were some way citizens had to let their elected officials know how well they were doing -- some means of getting their attention, or even to get them fired. Alas that will forever remain a dream. Not like the access citizens have to the upper management of outfits like Aetna.

so that people wouldn't lose their health care when they lost their job?

My neighbor has that. It's called a "union." The union collects dues from employers and pays for his health insurance. He can change his employer and his coverage is unaffected. Because the number of hours he works is subject to the vicissitudes of the economy, he banks benefit hours to draw upon when he's out of work.

Dust Bunny Queen said...

There are Medicare supplemental insurance plans, correct? If you want insurance coverage beyond what Medicare provides, you can go and get one of those plans. If you want a treatment that is not covered by your insurance, you can buy it with your own money.

Correct.

Medicare Part A is automatic for everyone eligible and it is very very minimal.

Medicare Part B is voluntary and costs a monthly premium. However, if you don't enroll when you are eligible you have to wait until the next year and your premiums will go up as a penalty.

Medicare Suppliment plans vary as to cost and what they cover and you must be enrolled in Part A and Part B to be eligible for the suppliment plan.

Even then they don't cover everything. Certain drugs are exempted from the plans and there can be caps on the total coverage.

Medicare and Medicare Supplimental plans also do not cover custodial long term care.

c3 said...

Insurance companies currently have a lifetime cap, generally 1 to 5 million dollars. You choose which level you want by the premiums you decide to pay.

The major payer(s) excluding Medicare and Medicare are employers. The majority of employer-based health plans don't have a lifetime cap.

The bigger impact on your premiums dollars is the size of the deductable you choose.

former law student said...

The only haircut will be to patients, who will get less time with doctors

"Less" time with doctors? The least time I ever had with a doctor was when I paid entirely from my own pocket. We spoke for some 90 seconds.

former law student said...

Nursing home care is not health care.

Pogo said...

"The least time I ever had with a doctor was when I paid entirely from my own pocket. We spoke for some 90 seconds."

Now you'll get 30 seconds, if that. The NP will see to that.
Savor that half minute.

AC245 said...

If only there were some way citizens had to let their elected officials know how well they were doing -- some means of getting their attention, or even to get them fired. Alas that will forever remain a dream. Not like the access citizens have to the upper management of outfits like Aetna.

If you don't like the plans Aetna offers or the way they do business, you don't have to do business with Aetna. You can choose to do business with another insurance company, or choose to do business with no insurance company at all and pay the costs of any health care you need directly.

But if, like 50-70% of Americans (depending on which poll you look at), you don't like the Obamacare plan, you and everyone else will still be forced by the government to participate in, pay for, and follow the rules and restrictions of Obamacare - even if every single one of the Democrats that forced it through are impeached or voted out of office.

I prefer the Aetna scenario.

peter hoh said...

Pogo, we can spend lots of money on lots of things. Defense, education, health care. Welfare. Roads. Bank bailouts. NASA.

All of these programs will suck up as much money as Congress throws at them.

Just because we can spend money, doesn't mean we should.

That's a very vague principle, not an endorsement of Obama's health care bill. Nor is it an endorsement of socialized medicine.

I am sure that you would agree need principles to guide decisions about public spending.

You might be surprised how much we agree about health care.

peter hoh said...

Pogo: Now you'll get 30 seconds, if that. The NP will see to that.

My father-in-law got an hour-plus visit with his primary doc back in April.

And an in home visit in June that lasted for at least half an hour.

Might help that they've known each other for 40 years.

former law student said...

If you don't like the plans Aetna offers or the way they do business, you don't have to do business with Aetna. You can choose to do business with another insurance company

http://en.wikipedia.org/wiki/Oligopolies

or choose to do business with no insurance company at all and pay the costs of any health care you need directly.

Have you priced chemotherapy lately, or a quadruple bypass?

Ignorance is Bliss said...

In the cost-benefit analysis, your improved chance of living may not be worth $8,000 a month.

Of course, the only people who can make a reasonable decision based on a cost-benefit analysis are people who care about the costs and the benefits, namely the people paying the costs and recieving the benefits.

Members of some government life panel do neither.

WV stingie. You can't make these things up. Well, you could, but I didn't.

AC245 said...

http://en.wikipedia.org/wiki/Oligopolies

A wikipedia link? :yawn:

Let me highlight the important parts of the portion of my comment you responded to, since you seem a little slow:

If you don't like the plans Aetna offers or the way they do business, you don't have to do business with Aetna. You can choose to do business with another insurance company or choose to do business with no insurance company at all and pay the costs of any health care you need directly.

Have you priced chemotherapy lately, or a quadruple bypass?

No, but if I was concerned about paying those future costs out of pocket, I could choose to buy insurance against those events instead. If I didn't choose to buy insurance, I'd have to live with the consequences of my choice.

bagoh20 said...

"Have you priced chemotherapy lately, or a quadruple bypass? "

If a therapy exists, it generally costs what it costs. The only differences are where the money comes from and where it goes, and how much is wasted in the transaction. This is what's wrong with government managed care. Much of the money will go to bureaucracy and lifetime bureaucrats that can't be fired, regardless of how bad they perform.

I prefer my money go to heath care providers, insurance companies, drug companies, etc who all have an incentive to do better continuously. Government entities will be looking for the shortest work week possible, knowing it will not effect their pay. This principle is really as clear, by now, as the roundness of the earth.

In a private system higher costs generally go to those who perform best, and for better technology; not 100%, but generally. In a public system, higher costs generally come from waste and fraud. There is little left for innovation and public system don't even attract innovative people. They attract those who are looking for safety and guarantees in their jobs.

JAL said...

Look, the discussion isn't so much about what Medicare does or doesn't allow -- the issue is whether Americans want the federal government to make more and more regulations which limit their healthcare choices. Which of course they will do because ... Well, because. (Hey y'all pro-choice people .. where are you now??)

For instance, NHS, the system Berwick *loves* will not let individuals purchase with their own little money, drugs that the "NICE" has determined they do not want to pay for for treatment. (Talk about creepy ... "NICE" for a panel that tells people they have to die sooner than later? More than Orwellian. Outright bizarre.)

There is a specific monetary limit (roughly $49,000 for what they approve). So, Peter .. how much *more* than $49,000 would be allowed? Instead of shooting for the moon, let's get to the nitty gritty ... When a PANEL (Hi Sarah!) gets to call the shots valuing lives by a $pecific number WHO sets the number?)

BTW -- did you know that Britain's NHS (2004) is the third largest employer In.The.World? Only behind the Chinese Army and the Indian Railway.

...Almost 1.3 million people — or the combined populations of Birmingham and Coventry — work for the NHS, which is one of the world’s biggest employers.
... 2 per cent of the 30 million people of working age....
Only the Chinese Army and the Indian State Railways are believed to employ more people — with 2.3 million and 1.5 million staff respectively — but both workforces represent a far smaller proportion of the national populations.....


We have had personal experience with some crazy regulations that Social Security has -- they are not "law," but Social Security has rules which turn out to be unchangeable. So don't talk to me about negotiating with people you can vote out ... nobody controls the internal workings of many -- most -- federal agencies. They regulate un-accountably. That is why we have an Office of Information and Regulatory affairs headed by Cass Sunstein -- so they can *regulate* what they can't put into the laws they do not read.

(HOW can ANYONE vote for people who do not read what they vote on as law for their constituents -- us -- to be subject to and controlled by?)

I'm getting pissed off, so I will go do something productive while there is still the light of day n the USA.

JAL said...

I hope I never have to collect on my home owners', my auto, or my liability insurance.

But I pay it.

Pogo said...

"My father-in-law got an hour-plus visit with his primary doc back in April.
And an in home visit in June that lasted for at least half an hour.
"

Hope he can keep that doc. The average US primary visit is around 10 minutes. I see people over 65 all the time who can't even find a primary MD.

Ignorance is Bliss said...

Pogo said...

So don't give me this 'we' shit. There is no 'we'. There's me, there's you, and there's a cabal of gummint bastards in control of my life. And they can all go to hell.

Forgot to take our Soma again, didn't we?

Pogo said...

Hah!

Dust Bunny Queen said...

The majority of employer-based health plans don't have a lifetime cap.



Yes they do.

The majority of employer based health care plans are provided by small businesses (which are the majority of businesses) that employ less than 100 people.

The plans have caps.

Your premiums are absolutely affected not only by the cap on the policy but, as you say, the deductible AND the levels of coverage.

Currently we can choose to have a high deductible plan with a low cap on lifetime coverage and exclude things like maternity and drug counseling.

Under Obama's plan, we will have less choices and no choices in those areas.

SH said...

Medicaid refuses all kinds of beneficial treatments. Even those shown to be very effective.

They'll let your kid go blind from an eye infection instead of paying for the drug to treat it.

damikesc said...

What I don't get is why would the FDA yank authorization? Unless the drug is actually dangerous, it seems to be political in nature. Its done to prevent the Left from having to conduct an honest debate about their plan.

chuckR said...

If only there were some way citizens had to let their elected officials know how well they were doing -- some means of getting their attention, or even to get them fired. Alas that will forever remain a dream. Not like the access citizens have to the upper management of outfits like Aetna.

Truer words were never spoken. Our elected officials have become as utterly unresponsive as the execs at Aetna and the like.

Voting those elected officials out doesn't seem to matter to the drive for increasing government control. If you think either the Dems or the Repubs have been responsive, you haven't been paying attention for the last two decades.

Hence the rise of the Tea Party sentiments and the non-Party party that both major parties denigrate as a threat to their perks.

SH said...

peter hoh said...

"Trad guy, if I came up with a treatment that cost $5,000,000 and extended the life of a colon cancer patient by two months, do you think the government should pay for it?"

No, but I'd rather not have the government involved. It's easier to go over the head of your insurance company (complain to your state insurance regulator and get their no stance reversed).

Also, I don't know enough to about it to completely explain it but from what I've seen these survivability rates tend to be off and/or tend to seem lower than they really are.

I have a chronic health issue that the stats say 80% of people die from within 5 years. But not only am I fine, everyone who worked in the field (I had a friend who specifically worked in treating people with what I have) and other RN and Doctor friends said not to sweat it. They were pretty confident I’d be fine… and they were right. Still, treating it can easily cost $200,000 something every 4-5 years (in real spending, not phony hospital billings for $8 advils)…

SH said...

chuckR said...

"Not like the access citizens have to the upper management of outfits like Aetna."

No, but in the old system the government and insurance companies were somewhat adversarial. You could use the government to put your insurance co in check.

That's gone. With Obama care, they're in bed togeather. This will be a mess...

chuckR said...

SH - you get no argument from me. Its the oligarchs, elites and mandarinate against the rest of the US.

I don't know if we'll be able to train the elected ones by consistently voting them out for enough elections to deliver the message that we demand limits to - and protection from - government.

Rich said...

I am no supporter of the HCR bill -- I think it's riddled with very serious problems.

But anyone who thinks the alternative of employer-based health care involves anything remotely resembling "insurance" is, thanks to rampant judicial activism, only kidding themselves.

c3 said...

If you wish you can make this a Democrat of Republican issue

but this is not a political issue

and its not sustainable, not in 2040 and certainly not in 2080

showbiz111 said...

Do you have to earn more than 8,000 per month gross to be considered a cost effective ingestor of this medication, or do your taxes have to be over 8,000 a month in order to qualify for it? What's a death panelist to do?
I'm sure glad that that 'whacko' Sarah Palin was sooo off the money on what the government would do with all these health care decisions! Why if she was right, democrats might stop people from getting food stamps (talk about a death panel) so they could fund a more favorable political ally. But the dems are soooo compassionate, that would never ever ever happen.

Lynne said...

Hugs and prayers, Irene. I will be pulling for you as I am for Mr. Cook.

Please spare a kind thought for my father, who is also being kept alive by a 'miracle' med.

May you both live to die of old age!

Irene said...

Thanks, Lynne.

Will do.

Ritmo Brasileiro said...

The WaPo says:

Citing a dearth of evidence of the drug's effectiveness, its potential toxic side effects, and its high cost, many cancer experts, patient advocates and others are welcoming the prospect that Avastin's authorization for breast cancer might be repealed.

To which, AA responds:

In the cost-benefit analysis, your improved chance of living may not be worth $8,000 a month.

What "improved chance of living"?

Is there no end to your lies?

Ritmo Brasileiro said...

Young Blood:

FDA listens to ODAC when deciding to approve an oncology drug. Congress has no input. Agencies have broad authority to actually act autonomously on the evidence they're presented with. Pharma, if anything, has much more sway than Congress, who don't even know the difference between a B cell and a T cell, let alone how to evaluate the efficacy of compounds trialed in cancer studies.

If you disagree, you can come to the next ASCO meeting and after sitting through all the presentations of the latest studies and trials, you can tell me how Congress is somehow nefariously and secretly influencing the people who are making decisions based on the same latest evidence that all the leading oncologists and oncology researchers are being presented with over several days.

Or you can continue to spout things without having any real-life knowledge of them.

peter hoh said...

I wrote: Trad guy, if I came up with a treatment that cost $5,000,000 and extended the life of a colon cancer patient by two months, do you think the government should pay for it?

SH responded: No, but I'd rather not have the government involved.

That's my position, too. Trad guy at 9:45 seemed to be arguing that any refusal to pay was tantamount to the government favoring cheap death over life.

It's easier to go over the head of your insurance company (complain to your state insurance regulator and get their no stance reversed).

And now, people are going to appeal to their senators and representatives, who will in turn apply pressure to the bureaucrats and/or write laws guaranteeing specific treatments.

I don't want medical decisions made by Congress.

peter hoh said...

Pogo wrote: Hope he can keep that doc. The average US primary visit is around 10 minutes. I see people over 65 all the time who can't even find a primary MD.

The doctor's house call came close to the end of my father-in-law's time in hospice. But my mother-in-law gets to keep him, until he finally retires. He hasn't taken on new patients for several years.

He's a good doctor, and I was privileged to be present for some of his long consultation with my in-laws back in April. At that point, my father-in-law had yet to enter hospice, but had drafted an end-of-life care plan with my wife and her sister, both of whom are nurses.

The doctor was quite impressed with the plan. Or at least he was kind enough to say so.

We lost our primary doctor to retirement five or six years ago. Unfortunately, I don't expect to ever again have a 10 year relationship with a primary care doctor.

Ari Tai said...

Pharma is not hugely profitable given the number of failures they must invest in (with no guarantee of success) to get one winner. This talk of obscene profits is similar to talking about venture capitalists if all their failures and write-offs are ignored. Planned economies have a hard time matching the effectiveness of the random walk of a market with its “try 2-3 times to get a good result.” We see it in our own government agencies where they frequently have to spend 5-10x commercial to get a working information system against a given need. Unfortunately, government can’t fail and close its doors like business (and get the advantage of a new set of intellects with likely better judgment in their next attempt).

Perhaps we should offer state support in public clinics, publicly funded teaching hospitals of any medicine and procedure in common use, say, 20 years ago (1990). Everything more recent is the individual's responsibility. Note that without some way of we're going to see everyone getting N-year-old care as medical and pharma research stalls and stops. Using a 20 year old list (perhaps derived from the practices and pharmacopeia of the top 4 teaching hospitals of the day) has the advantage of being an easily understood process without the argument of what should or should not be on the list.

Challenge is few will notice the lack of medical advance (sins of omission – opportunity costs are seldom tallied). Perhaps some will document the slow-down in the rate of innovation. Hopefully some other nation will pick up the slack and we'll find yet-another-trade-deficit in medical-tourism, but at least progress won't stop. Similar to the only country you can go to for major surgery today where facilities have been built from scratch to be and remain MRSA-free is India. Not insignificant given the medical art is still (accidently) killing 4-5x more citizens than die in automobile accidents today. In one thousand years (presuming we repeal Obomacare and not innovation), I’m certain our practices will be viewed as closer to medieval than advanced.

Obamacare is all about leveling death and misery (and sadly stopping innovation). Could easily exceed the costs and losses of communism where billions of peoples' lifetime of work were utterly wasted, where the outputs of their factories were often worth less than the inputs (granted, not the peoples’ fault save their unwillingness to die to throw off their slave-master's shackles – or grant that here’s a fine reason to define a higher power than any state).

And/or we’ve a need for a general social contract that’s a sliding scale between treating-like-a-child and the freedoms and responsibility of an adult. Meaning the more you’re dependent on (the family or) state, the more constrained your freedom and actions are. At one extreme we assign a barracks bunk, administer birth-control in the daily rations, and do some form of manual-labor to get fed and clothed. At the other-end is a free-and-responsible person. Where there’s no picking and choosing. If you need the state to provide healthcare (or housing, or education, or non-self-funded pension), you get the rest of the “we’ll care for (and manage) you” contract as well.

former law student said...

Obamacare is all about leveling death and misery (and sadly stopping innovation).

Why must we be the saps always footing the bill for pharmaceutical developments the world enjoys for next to nothing?

Republicans want Americans to be saps -- first by slashing Social Security benefits, now by loading up the cost of pharma R&D.

Ignorance is Bliss said...

fls said...

Why must we be the saps always footing the bill for pharmaceutical developments the world enjoys for next to nothing?

So you think America should go Galt?

Ari Tai said...

re: going Galt.

Consider an accounting rule that companies should charge the same for a product in all equivalent settings, as adjusted for tariffs, taxes, quantities and (committed/contracted) revenues. i.e. one published price sheet / spread sheet - put what you want to order - products, volumes and delivery coordinates in (time and space) and get a firm-fixed price.

Would make re-importation a non-issue.. and be the equivalent of "going Galt" - either pay what everyone else pays (at the same contractual and tax terms) or do without.

Roughly the equivalent of laws that (attempt to) prohibit bribery.

Where charity is appropriate, make it explicit, rather than a component of price – and/or a condition on the license to do business locally. Consider that once-upon-a-time these free-trade related issues were the challenges that justified the State Department’s existence.

Else we're agreeing that someone (other than the random walk of the market and two entities acting in their own self-interest - a process that has historically resulted in the greatest common-good and fairest distribution of returns by orders of magnitude) will be deciding both the direction and pace of innovation. In the 90s we saw what this meant for government agencies taxed to deliver the peace dividend. Little new hiring. Stagnant if not falling research funding. And eventually a decayed infrastructure (leading to the IC being deaf and blind - and arguably 9-11). Same as we have seen w/ Britain’s NHS.

Youngblood said...

Ritmo,

Whatever you were responding to, it wasn't what I wrote.

It is a fact that the FDA's rules and authority ultimately stems from Congress. It is a fact that the FDA's policies have been changed by amendments to the Federal Food, Drug, and Cosmetic Act. It is a fact that Congress can change the rules that the FDA operates under.

I'm sorry that these facts are inconvenient to you, but you'll just have to deal with that.

Careless said...

$8,000 a month is absolute peanuts for chemo compared to some. I believe my mother cracked seven figures with her leukemia treatments.

Irene said...

The view from the Telegraph.

Ritmo Brasileiro said...

I'm sorry that these facts are inconvenient to you, but you'll just have to deal with that.

I hate to inconvenience your politicking, but when was the last amendment to the FDC that substantially changed the way drugs are approved in this country and how did it do so?

Whatever you were responding to, it wasn't what I wrote.

The fact is, you don't seem to know enough about science to understand the basis by which apolitical judgments regarding the safety and efficacy of human medications are made.

That's a kind of judgment I can see the Republicans meddling with, but not the left. Maybe that's worth worrying about once the paranoid dystopian dream sequence that Randians and Republicans fantasize about comes to pass. But not before.

Once again, I invite you to show me how ODAC's pronouncement re: Avastin was political and not grounded in science. Debate the science with me all you want. If you dare.

But why do that when you can just make a hypothetical political point and are partial to the party that has lost any sense of principles, restraint or respect for empiric judgment?

Read your history. There's a reason the agencies were created: The executive branch needs to delegate routine responsibilities to organizations with the autonomy to act in a specified area of expertise. There has not been a significant problem with politicizing these agencies, until Bush tried to substantially change the mandate of EPA and perhaps others (even FDA). If anything, I would worry more about the executive branch, not Congress, misusing, meddling with and misdirecting the agencies. But I suppose that would give you a conspiracy scenario that, while more plausible, has even less evidence to support it during this administration.

But it would be a page from your side's book, if it happened.

Jakester said...

Still pedaling your paranoid conspiracy lies? I can understand a barely literate political fool like Palin running her stupid mouth about this, but an alleged intellectual rubber stamping her lie is pretty contemptible. Keep up the good work, ginning up your mental midgets with such nonsense.