US breast cancer drug decision 'marks start of death panels'

[RamboLiberal]

Source: Telegraph.co.uk

A decision to rescind endorsement of the drug would reignite the highly charged debate over US health care reform and how much the state should spend on new and expensive treatments.

Avastin, the world’s best selling cancer drug, is primarily used to treat colon cancer and was approved by the US Food and Drug Administration in 2008 for use on women with breast cancer that has spread.

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David Vitter, the Republican Senator for Louisiana, said the FDA decision amounted to rationing health care.

"I shudder at the thought of a government panel assigning a value to a day of a person’s life," he said. "It is sickening to think that care would be withheld from a patient simply because their life is not deemed valuable enough.


Read more: http://www.telegraph.co.uk/health/healthnews/7948878/US-breast-cancer-drug-decision-marks-start-of-death-panels.html

[sinkingfeeling]

1. Oh goodie! Let's get the Teapublicans to dismantle the FDA as well as the Dept. of Education and

the entire Bill of Rights.

[superconnected]

18. He would if he could. Many Republicans really do want all that.

[onehandle]

2. A: Hookers, diapers, and a woman assaulting employee.

Q: What do you think of when you see David Vitter's name?

[KamaAina]

3. "However, two new studies have shown that the drug may not even extend life by an extra month. "

There goes the whole "cost effectiveness" argument. You'd only be paying for it for one month -- because it doesn't work!!

Leave it to the Torygraph to quote Diaper Dave as the voice of reason. :eyes:

[hedgehog]

8. Not only that - but

Serious side effects with Avastin include:

* The formation of an abnormal passage from parts of the body to another part, sometimes fatal. Stop Avastin therapy if this occurs
* Stroke or heart problems, which can be fatal. Heart problems include blood clots, mini-stroke, heart attack, and chest pain. Stop Avastin therapy if these occur
* Too much protein in the urine, which may lead to kidney problems, sometimes fatal. Your doctor will monitor your protein level and may stop Avastin therapy if your level is too high
* High blood pressure. Your doctor will monitor your blood pressure and may start you on medications to control your blood pressure. Temporarily stop Avastin if not controlled with medications. Avastin should be stopped if blood pressure severely spikes or if disturbance of the brain from high blood pressure occurs
* Nervous system and vision disturbances. Symptoms may include high blood pressure, headache, seizure, sluggishness, confusion, and blindness. Stop Avastin therapy if these symptoms occur
* Infusion reactions. These may include high blood pressure or severe high blood pressure that may lead to stroke, difficulty breathing, decreased oxygen in red blood cells, a serious allergic reaction, chest pain, headaches, tremors, and excessive sweating. Stop Avastin therapy if severe infusion reactions occur

What are the most common side effects of Avastin?

The most common side effects of Avastin that occurred at >10% and at least twice the control rate include nosebleeds, headache, high blood pressure, inflammation of the nose, too much protein in the urine, taste change, dry skin, rectal bleeding, tear production disorder, back pain, and inflammation of the skin.


http://www.avastin.com/avastin/patient/

[FlaDem83]

11. I haven't posted in a veeeery long time

and the reason is I was diagnosed with metastatic breast cancer. At age 30. As my initial diagnosis. Rarest of the rare. I am in remission, completely, and am on a drug called Herceptin, which basically a silver bullet for women who are Her2 positive, for life. However, there are some women whose cancer is not eligible for Herceptin but do respond to Avastin. And in fact, there are women whose lives are greatly extended by the use of Avastin, and whose mets are kept stable for years. To deny coverage to these women is unconscionable, and the effect of Avastin in different subpopulations of triple negative breast cancer patients has not fully been studied.

[KamaAina]

13. In that case, study it!

That'd also be a good way to give people access to the drug by enrolling them in the clinical trials.

[Lightning Count]

16. And if you aren't eligible for the trial, then you are just collateral damage.

The right wing loves that kind of attitude. I think all treatment options should be open to all patients regardless of cost.

[hedgehog]

34. A note of caution: back in the 80's, when being HIV+ was a death

sentence, there were no treatments, just experimental drugs. Under pressure from desperate people, the FDA released drugs that hadn't been tested. It was only years later that it was determined that some of those drugs were ineffective and/or had been given at the wrong dose and/or actually killed the patient after causing a long list of distressing side effects.

When it's your life or a loved one's life, you want to grab any chance possible. It's very hard to hear the warnings that this drug may not work or may make things worse. It's even harder to be told that the drug might have worked before you reached this stage of an illness. The trial protocols are set to get as clean a yes or no answer as possible.

[Lightning Count]

35. That is not the case in this instance though.

We know the drug works. The degree to which it extends life is the debate. Even if we take the article at face value and it only grants people one month's life extension and they want to take advantage of it through their insurance then they should be able to do so.

Or should we deny terminal cancer patients chemo and radiation because it's expensive and the return on investment is not good?

[hedgehog]

36. I suspect we are dealing with a quality of life issue here.

The drug is not a cure. It has numerous side effects. I wonder how many people actually died from the side effects rather than the original cancer.

This isn't a case of denying terminal patients something that is expensive. Intubating someone and placing them on a ventilator is a routine practice. Yet when the man who was going to be my brother-in-law was dying with Hodgkin's, he reached a point at which he refused the ventilator. He traded a few more days (maybe) for the ability to speak with those he loved.

[Lightning Count]

37. Then we should start relooking at all chemo and radiation therapies.

Your future brother-in-law had a choice. The same choice that we should afford to all patients. All known treatments should be an option.

By the way, all 3 studies confirmed that the drug prolonged life. Its just the amount of prolongation that is under debate.

[hedgehog]

39. There's very little detail in the article, but

"two new studies have shown that the drug may not even extend life by an extra month. "

Choice is one thing, but do we want the FDA approving drugs that don't work?

Several years ago, women with breast cancer were offered bone marrow transplants. Prior study of this technique to treat breast cancer was very limited because it seemed so logical. Who wanted to be assigned to the control group and go without a bone marrow transplant? IIRC, ttansplants are no longer done not because of the cost but because they did not prolong life for women with breast cancer. Again, bone marrow transplants are still used in treating other diseases.

[Lightning Count]

40. An extra month is working.

It should be an option.

[hedgehog]

15. The article at the link says that studies will continue. It sounds as

if the drug may be effective for a small sub-set. That sub-set needs to be identified so as to spare the women for whom it is not effective.

[Lightning Count]

17. And how will the subset afford the drug since insurance will not cover it?

You won't know if it's effective until it's tried on you. Big Insurance wins again.

[hedgehog]

21. My read on this is that for most women, this drug provides

up to an additional month of life spent in great discomfort. If you live longer, but spend it in the ICU, is the drug worth it?

What I expect to see is that after some further studies, the drug may be approved for women whose cancer cells have characteristics A, B but not C. It is also possible that after further studies, it may be found that the drug does not dependably treat metastatic breast cancer. Some cancers do go into spontaneous remission. It may be that in the cases where this drug looked effective, the cancer went into remission on its own.

[Lightning Count]

29. From the article:

"It costs $8,000 (£5,000) a month and is given to about 17,500 women in the US a year. The drug was initially approved after a study found that, by preventing blood flow to tumours, it extended the amount of time until the disease worsened by more than five months. However, two new studies have shown that the drug may not even extend life by an extra month."

Which studies do you bet were funded by Big Insurance. Isn't is amazing that they always find this out about high cost treatments?

[musette_sf]

38. + 1

thank you for a voice of sanity here.

[CLANG]

31. Avastin may cause death in several ways

"Stop Avastin therapy if these occur".

right...

[Lightning Count]

9. A "study" also said that preventative mammograms were not necessary.

May want to consult some breast cancer survivors about that.

[hedgehog]

12. Mammograms are not preventive; they identify the presence of cancer.

If the cancer is slow growing, does early detection make that much difference in outcome? If it is fast growing, does early detection make that much difference in outcome?

What happens if a fast growing cancer develops after a clean mammogram? Should women have monthly mammograms?

What about men? Some men get breast cancer, should men be getting mammograms?

[Lightning Count]

14. Ask the poster in post 8.

She likely has the answers you are looking for.

[hedgehog]

23. Actually, I am poster # 8! Let me give you some additional

information on why I raise these questions:

My elderly mother had a mammogram and it was determined that a lump in her breast that she had had for years had turned cancerous. The doctors recommended a mastectomy and after a great deal of emotional distress she consented. Now, the doctors gave the best advice they could with the information at hand. What we may never know is whether the surgery extended her life or not. What would have happened had she not had the surgery? Was the cancer aggressive enough to kill her? In other words, had she not had the mammogram, would she ever had realized that she had cancer?

[Lightning Count]

28. Near-sightedness

Meant poster 11. I have a friend who runs a breast cancer charity. Many lives have been saved including many women in their 30's and 40's. The reaction is always the same. "Thank goodness we caught it in time."

[Lightning Count]

4. Disgusting that they would deny this to women.

"The FDA advisory panel has now voted 12-1 to drop the endorsement for breast cancer treatment. The panel unusually cited "effectiveness" grounds for the decision. But it has been claimed that "cost effectiveness" was the real reason ahead of reforms in which the government will extend health insurance to the poorest.

If the approval of the drug is revoked then US insurers would be likely to stop paying for Avastin"

Giveaway to Big Insurance.

[alcibiades_mystery]

27. "But it has been claimed..."

By whom?

[Lightning Count]

30. By people other than Big Insurance flunkies. nt

[alcibiades_mystery]

32. Which ones?

I'm serious. Who made that claim? The effectiveness claim is a scientific claim, while the "cost-effectiveness as real, secret reason" is a political one. Who made it? Show us.

[hughee99]

5. If this was a repuke administration and a Democrat stood up and said this,

we'd all be cheering him, and in addition, calling it sexist that it's ONLY being rescinded for breast cancer.

What's wrong with this drug that it's no longer going to be recommended? It's expensive and instead of extending the time it takes for a disease to get worse by 5 months, it may only extend it by 1 month.

[Lightning Count]

7. Amazing that when the insurance companies says jump.

The FDA says how high.

[tsuki]

6. Vitter needs to talk to his buddy, Rep. Paul "Death Panels" Ryan.

That is exactly what he is advocating.

From Ezra Klein:

"Under Ryan's plan, senior citizens would be given vouchers that they could use toward private insurance. Poor seniors would get more-generous vouchers, and rich seniors would get less-generous vouchers. The way Ryan saves money is by holding the growth of the vouchers beneath the growth of health-care costs, so as care costs more and more, the vouchers cover less and less."

http://voices.washingtonpost.com/ezra-klein/2010/08/paul_ryans_plan_would_end_medi.html

[Vinca]

10. Actually, the real death panels happen when a person is kept

from getting an early diagnosis because they lack the backing of big insurance. If they happen to stumble upon a free clinic for the diagnosis, they then get to beg for their lives at a hospital door or just go home to plan for the end. It happens every day in this "the greatest nation on earth."

[superconnected]

20. And also when they do get a diagnosis but can't pay for the drugs or the treatment.

[hedgehog]

19. Food for thought on this entire issue:

"Modern medicine is good at staving off death with aggressive interventions—and bad at knowing when to focus, instead, on improving the days that terminal patients have left.

Read more http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande

[Iowa]

22. Deleted

[smuglysmiling]

26. exactly...

it is about making someone's Mercedes payment, not quality of life. And it is not just with cancer treatments...other specialties are as bad if not worse at getting paid for poor outcomes...

[hedgehog]

33. The article at the link is a good one and clearly lays out why

so many doctors and surgeons keep on trying; it's not about the Mercedes. I think the point of the article is that modern medicine can do an awful lot to keep you breathing when what we really want to do is to keep living.

[smuglysmiling]

42. if the treatment only

keeps you alive but gives you no quality of life...then it is palliative care...money spent for ineffective treatment....or lining the pockets of the providers making their Mercedes payment. The chamber of commerce will tell you how great a town is because they have a vested interest. Medicine is no different in many areas....cancer treatment being top of the list.

[hedgehog]

24. This story could just as easily been about the FDA stopping

Big Pharma from foisting an ineffective but debilitating drug on terminal cancer patients in order to increase profits.

[IggleDoer]

25. The drug didn't work ...

So let's see, Vitter and the Repubicans want to give patients the "right" to have this ineffective drug anyway, even though it only works to give the drug companies more profits. NOW who's the real death panels here?

[hedgehog]

41. Web MD has more details: "

"clinical trials showed little evidence that breast cancer patients benefit by adding Avastin to chemotherapy. The drug increased the rate at which these patients experienced serious side effects.

http://www.webmd.com/breast-cancer/news/20100720/fda-panel-avastin-not-for-breast-cancer