No cure for cancer

A few years back - CNN went national with the story of a father of conjoined twins.

He'd asked doctors to surgically separate the children - the operation was extravagantly expensive and unlikely to prolong the lives of the two children (who had a host of other medical problems).

The thrust of the coverage was - should society have to pay for this operation, when the odds are against it resulting in any benefit to the children?

The operation went forward, the money was spent, and the children died.

A good amount of abuse was leveled at the father of these twins. How dare he ask us to finance a no-hope procedure?

Classic CNN: Simplified, emotional, and tacky as all hell.

The Isthmus has what I think is a responsible treatment of this same issue. There are really tough choices that don't make it into the public discussion.

Jacqueline Sutton relates the story of a patient using a drug called Avastin:

Avastin is part of a newer and more expensive generation of cancer medications called biologics, or targeted therapies. Unlike chemotherapy, which attacks cancer in a scorched-earth fashion, targeted therapies hone in on a specific aspect of the cancer disease process, and interrupts it in any number of ways.

But Avastin's exciting potential comes with a high sticker price. For an average-size person, a regimen that includes Avastin and chemotherapy can cost $11,000 a month just for the Avastin. That compares to about $300 a month for paclitaxel (the generic form of Taxol) and about $1,500 for Taxotere.

[snip]

The cost might be easier to justify if there were not also concerns about Avastin's long-term effectiveness. A clinical trial involving 700 women found that Avastin extended a tumor's time to progression by about six months for half the patients who received it as part of a combined regimen.

But in most cases the tumor will eventually progress. That is partly why an advisory panel, on a 5-4 vote, recommended against approval. But the Food and Drug Administration decided against this advice.  

The article does a nice job of spelling out the brutal choice that is being made here. Do people get access to this drug? Is it worth it?

Then there was this observation:

For James Stewart, a medical oncologist formerly with UW Health, cancer has a "favored-nation status in the medical community" due to the dreaded nature of the disease. "Any cancer drug that shows even minor improvements becomes the new standard, regardless of cost." He is convinced this has not only driven up the cost of treating cancer, but contributed significantly to the rising cost of medical care in general.

Nobody wants to think care will be denied on the basis of money - but spending money for the greater good will require some judgment calls, and they will not be fun.

For most people, cancer is not an abstraction. How do you say no when people are suffering? or dying?

But while there is only so much money, the supply of worthy patients is bottomless. This country is far too good at equating price with quality - resulting in the reflexive carpet-bombing of our problems with cash.

If we're going to help the most people, we have to get the most value for what we spend - and that will mean less cancer drugs on the market - and telling the fathers of conjoined twins "we are not going to operate."

It's a horrible thought.  But it must happen.