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Thursday, October 24. 2013
The Cancer Drug Racket
If $300,000 buys you a statistical chance of living a few more days with a terminal cancer, would you take it? Would you take it even if Medicare paid for it - which it probably would?
Cancer chemotherapy is a big business: The Cancer Drug Racket:
Posted by Dr. Joy Bliss in Medical, Our Essays at 12:02 | Comments (11) | Trackbacks (0)
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Can you imagine what a financial disaster for the medical community if there actually was a cure for cancer?
It really wouldn't be as large a financial disaster as you assume.
The 'cure' would command a hefty price, in and of itself. But more importantly, other diseases or problems would take center stage.
An example, though from a completely different standpoint, is what my father went through (he was a plastic surgeon) when the lawyers killed silicone implants. Well over 50% of his business was derived from silicone implants. While saline implants were a viable alternative, he saw his business decline significantly in the first few years of the silicone lawsuits. However, at the same time, the skin cancer issue started becoming more prevalent. It's no coincidence.
The same people who were so concerned with their looks, and getting implants, are also the same people who spent a great deal of time out in the sun, developing skin cancers. His business shifted, like any other business.
While that example isn't exactly perfect, it's informative. Doctors who specialize in these fields have capabilities which can easily transfer to deal with other life-threatening diseases.
It's also worth noting that all cancers are not exactly the same. A 'cure' for leukemia is highly unlikely to 'cure' breast cancer or colon cancer. Each cancer is significantly different, as are the treatments. The concept of "A Cure for Cancer" is a very broad statement. My sister-in-law just went through a year's worth of treatment for breast cancer (she is young, and it was at a stage with only 40% survivability) and spent a considerable sum on having it dealt with. She was declared cancer free only a few weeks ago.
Meanwhile, my niece was diagnosed with pre-cancerous polyps in her colon. The treatment will likely be long term (she's only 9), but at this point it's ongoing treatment and observation.
At the same time, my uncle is dealing with a prostate cancer which required surgery, in and out in a day. Early detection, high survivability rate.
In most cases the cost, the treatment, and all the issues you THINK would be dealt with by a 'cure' are determined by things like history, awareness and detection, and the type of cancer in question.
Fun to say "a cure for cancer" and have high hopes for just such a thing. The reality, of course, is something altogether different.
yes, "cure for cancer" is an impossibility. There's hundreds of forms of cancer, each with its own "cure" (IF there is a possible cure that is, there's still many that are a death sentence, and many more that you have to get really lucky to survive, mostly meaning it has to be caught in very early stages).
My mother was diagnosed with blood cancer last week, supposedly has a 50-70% survival rate depending on exact form, but by the time they discovered it in her body it was too late, she has been given a few months to live, a year at most.
Having seen a few close, younger friends with cancer (all of whom died), I would not want extreme measures to extend my life a few days. All of my friends suffered through the last few months of their lives due to chemo or other treatments intended to extend life.
Chemo/radiation is brutal on the body. Repeated chemo/radiation treatments with a low percentage of success, in my opinion, seems cruel and inhumane.
This, obviously, is coming from a non-doctor and anecdotally from friends' experiences. However, it left me convinced that doctors want to please family members more than be honest with them about treatments and survivability rates. Does grandma at 85 really need to be suffering even more just to give her a couple more days of life?
If any of you have seen a family member or friend in the last few days of life with cancer, that person is usually in a fog of pain medication and barely aware of what is going on around them. Is this really something we want to extend?
It's unfair to lump it all on the doctors. I don't disagree that some are probably just in it to keep people happy. But most doctors I've dealt with (admittedly, as a doctor's son I tend to ask many questions) are pretty honest about what the options are and what the outcome is likely to be.
A very good friend of my family's has a mother who has been incapacitated for many years. Our friend's wife has been a stay-at-home caretaker for the woman. Recently, the mother developed cancer (she's very old, over 80, and is on a feeding tube already). Financially strapped, they chose to have her undergo treatment DESPITE the doctor, the parish priest, and friends all suggesting she not get the treatment, and only get a visiting nurse service to ease the pain and help her through the final stages.
Now the stay-at-home wife has more work to do, they're in even worse financial shape, and it's not a topic for discussion, because mama must have her treatment.
I'm not one to judge. We want things for emotional reasons, and clearly someone just isn't willing to let go. The doctor must live up to his oath and provide the care requested, though he informed them that it's not really going to enhance her life in any way, and will cost a fortune.
And people wonder why medical costs are out of control?
I'll refer you to one Hillary Rodham Clinton, whose father received extraordinary care at the end of his life. Care that was over and above the usual for a man his age, and at a time when this woman was seeking to deny others the same access.
I don't deny her the right to get that care for her father - it's a choice. But she had no right to be pushing an agenda that would deny me the same rights she had (though I likely would've made an entirely different decision than her).
A member of our family began with testicular cancer. It moved to throid, jaw, bones, etc. In the beginning it was chemo/surgery and a two year survival prediction. There have been 8 surgeries and multiple, multiple treatments. For seven years each treatment produced improvement and a reduction of cancer, ending with a projection of at least another year of relative quality of life. Each year he recovered mostly and got strong enough to enjoy travel and hobbies, etc. Last year at this time he was again weak, frail and deathly ill. NEW TREATMENT began in January and just several weeks ago we were all relieved to hear that he was "Cancer Free"! Fortunately for him he was a teacher all his life and thus had very good union medical insurance!!
In the last 8 years 5 different close relatives died from what began as smoker caused lung cancer. Without exception the cancer metastasized to the brain and it was there that the effects caused death. Two of them were cared for by my wife and I in the last months of their life. As a lung cancer survivor myself I can tell you that no matter how deep the sorrow of a diagnoses and passing of a close family member can be it pales by comparison to getting that diagnoses about yourself. I am on my second bout with this cancer and it is only now after 8 years that my own personal experience and my recent experience with family members even comes close to giving me any peace with this disease and the inevitable death it causes. My point? Until you are sitting in the office and get that grim news yourself yu don't really know how big that impact is. Would I spend $300,000 for a chance to live a few years longer? Maybe! Would I, if I were sitting on a death panel, spend $300,000 so YOU could live a few years longer? Probably not. For better or worse Obamacare will end the cancer drug racket.
You are so right Gone. It's easy to be pragmatic and practical when you're talking about someone else. $300,000 to live a few years longer. You betcha. The government is not paying for my care yet and I resent anyone questioning my right to seek care.
You've got it exactly correct!
The problem is NOT the doctors or even the drug companies. The problem is in our system of breaking the connection between the consumer and the supplier. In normal free markets, the consumer of the medical service would trade something he values less (in this case dollars) for something he values more (medical care) and the supplier does the same. In such markets, the consumer must weigh the cost of receiving or not receiving the care with the benefits of receiving such care.
Under our current system, consumers don't see or feel the true cost of the care. In the case of working age people, they feel the cost is being borne by the employer. In the case of the Medicare patient - the age group that incurs most of the cancer costs - the large majority of their insurance costs are borne by younger taxpayers. If seniors were paying the true cost of their insurance the premiums should be in the THOUSANDS of dollars per month instead of $105 per month. Does anyone really think that $105 per month (the current part B Medicare premium) covers the insurance costs for someone over the age of 65. Does it make sense that a 75 year old pays $105/month and a 30 year old pays twice that amount? And, NO, there is no Medicare trust fund that you seniors paid into that is paying for your Medicare benefits.
Now, don't get me wrong. I'm not against insurance. However, consumers should see the true cost of insurance. If you want mega-expensive treatments (like $300K per year chemo), you should pay the high costs yourself or pay the higher costs of an insurance that covers such treatments. This is fair. If YOU want expensive care, let that be your choice....but you also need to bear the responsibility for such care. It is morally repugnant for these BASTARDS at MSK to refuse to provide the best care possible which is exactly what they are doing. In essence what they are saying is, "Even though YOU are willing to pay for the best drug, because we feel that everyone can't afford it, we won't let you have it!" Should we deny Dr. Saltz his expensive Cadillac simply because everybody can't afford to drive one?
GWTW is correct about not truly knowing until you're the one. I was just declare cancer free from colon cancer. Found on routine colonoscopy. I never had a symptom or sign.
But the diagnosis does majorly mess with your head. You may sympathize and empathize all you'd like. But you can not truly understand until you are diagnosed with a malignancy. And I truly, sincerely, deeply hope any who read this will NEVER be able to understand.
In my case, while I still have private insurance, I decided to fight like hell. Fast and aggressive treatment. I had to because, like all veterinarians covered by AVMA insurance, my insurance is dropping me 31 December.
Not afraid of death. But I sure as hell haven't had all the fun I can have here. So I'll stick round a bit longer, if you please.
For what it's worth, I agree with GWTW. I haven't had to deal with this personally, so I have no idea.
My wife and I have agreed that if extraordinary circumstances are in play, both of us would agree to a DNR, so perhaps that informs what my view is to a degree. But if I'm making the decision for myself, the questions I would ask are:
1. How long and what are the odds of longer survival?
2. What would my quality of life be during and after treatment?
3. What extenuating circumstances and extraordinary care should I be prepared to engage, if any, and how might that impact my finances?
There are probably a few more questions I'd ask, but these are the main ones.
Generally, the answer is no - I wouldn't. My aunt (yes, there have been a number of cancer items in my family recently) died of colon cancer last June. After treating it aggressively for several years, she realized the fight wasn't worth it.
She was a Liberal die-hard, but I don't know if she used Medicaid. I doubt it. Not that she couldn't or wouldn't, just that I know she made money on a couple of stock recommendations I'd made over the years, and she had a pretty good pension through her husband (who died in the 80's from pancreatic cancer).
It's funny, but I never stopped to think about how many people in my family have had brushes with cancer, but for a family the size of mine, it's quite a few. Very few, interestingly, are blood relatives. When I think of how large my family is, and I reflect on the number of members who I know have dealt with cancer, it's about 5%, of which about 1% were blood relatives.
I just checked, and both percentages are pretty high if you think of cancer of all kinds as a single entity. Good thing I visit my doctor regularly and don't smoke, I guess.