British Balance Gain Against the Cost of the Latest Drugs - How much is a life worth?

[groovedaddy]

RUISLIP, England — When Bruce Hardy’s kidney cancer spread to his lung, his doctor recommended an expensive new pill from Pfizer. But Mr. Hardy is British, and the British health authorities refused to buy the medicine. His wife has been distraught.

“Everybody should be allowed to have as much life as they can,” Joy Hardy said in the couple’s modest home outside London.

If the Hardys lived in the United States or just about any European country other than Britain, Mr. Hardy would most likely get the drug, although he might have to pay part of the cost. A clinical trial showed that the pill, called Sutent, delays cancer progression for six months at an estimated treatment cost of $54,000.

But at that price, Mr. Hardy’s life is not worth prolonging, according to a British government agency, the National Institute for Health and Clinical Excellence. The institute, known as NICE, has decided that Britain, except in rare cases, can afford only £15,000, or about $22,750, to save six months of a citizen’s life.

http://www.nytimes.com/2008/12/03/health/03nice.html?th&emc=th

[ben_meyers]

1. And that is why private companies have to be nationalized

and medical services taken over by the Government. Why can't we have public ownership of the development and distribution of these vital services. It should be like the post office or the dept. of motor vehicles, efficient and available to all.

[dmallind]

5. OK. Which drugs should American Pharmaceuticals produce?

How much of our collective money should we invest in a 20yr research effort for a drug that may or may not work, and may or may not have dangerous side effects, for a disease that affects only a few hundred people? Or even the biggies - should the research go into promising but incremental new lung cancer options or highly speculative but potentially game-changing breast cancer?

Do we hire many many times as many leading experts as industry has and try for all of the above in all cases? From where do we get these people since H1 visaa are anathema to DU? How much do we pay the best ones? Federal employee scale doesn't go as high as they can get elsewhere, or are used to in private employers here now.

If the FDA and Pharma are both government agencies how much risk or definitive side effects is too much for a drug that could save the government billions by preventing, say, colon cancer but risking liver failure in a smallish number of cases?

I've worked in pharma and related industries for years. God knows it can be done a lot more efficiently, although a lot of the inefficiencies are imposed by (what would be in your case) other government agencies who are living in the 1950s and think only a signed piece of paper at ecery stage can demonstrate that something was processed correctly. God knows US customers are being raped in pricing, and God knows the excuse about R&D being the primary beneficiary of those high prices is bullshit since every big pharma company I know spends at least 3 or 4 TIMES as much on sales and marketing. Trust me I am far from blind to the greed and waste and incompetence of the industry, and would welcome much more regulation in the areas of marketing and so on. But nationalizing pharma would be far more likely to create problems than solve them - just different ones. I know of no example of a successfully nationalized drug research industry either now or from history. France does not try this. Canada does not try this. The UK does not try this. Scandinavian countries do not try this. Many nationalize the delivery of healthcare, but not the development of the drugs themselves. There is a reason for that.

[LeftishBrit]

7. We do have a National Health Service..

but unfortunately it has been undermined by right-wing cost-cutters, Tory and Labour-in-name-only.

In America, it's the stingy insurance companies; in the UK it's the right-wing governments placing cost ahead of needs. (And how much money might we have saved for the NHS if we hadn't got into Iraq!)

Other Europaean countries don't have the same problem to the same extent; and indeed it happens much less in Scotland than England; so it's not an inevitable consequence of socialized medicine, but of a government with particularly disgusting attitudes to health.

[Fire_Medic_Dave]

11. So how much are you going to pay the doctors?

Are you going to limit the wages of other industries?

David

[dmallind]

2. This is unavoidable

The issue is not that of parsimony but of results and prioritization. If you look at the probability of extra life (the snip implies 100% which is unlikely) and the quality of the extra life (he still has what is an advanced and doubtless painful cancer) there MUST be some triage, or we face the prospect of 95yr olds being given six figure treatments which may or may not give them a few extra days in agony. This kind of extreme example may not be as unlikely as you think. Prolonging life under many conditions is not that hard as long as you care nothing aboutvteh cot of it or the quantity of it.

So only in a dream world is no line to be draw. The question is of where to draw it. Because not only is that six months an uncertainty but it's doubtless also a mean with some, probably significant, variation. And because what is tolerable or desirable to some as far as prolonging life goes may be undesirable and intolerable to others - as can be seen over the DNR issue.

Is this particular case "fair"? Who can say without being the man in question or his doctor? But the idea of rationing care is an unavoidable corollary of shared and limited resources.

[ben_meyers]

4. Oh B.S. Remove the capitalistic profit motive and

you solve the problem. It's greedy "private enterprise" that has ruined the medical systems world wide. Health care is not a business, it's a human right and must be shared by all regardless of age, wealth or so-called lifestyle choices.

[dmallind]

6. See above

I'm fine with reducing pharma profit margins, but that just lowers the limits and does not remove them by any stretch. Again - unless you want to prolong the life of a senile mentally incompetent nonagenarian in endless agony just because we can, even though the same investment could, say, innoculate thousands of kids, the only question is where you draw the line.

[Liberal Gramma]

3. I know this sounds hard-hearted, but...

having watched and cried over the last six months of my mother's battle with cancer, I'm inclined to agree. If the pill cured the cancer, it's worth any cost. If it just prolongs a life already blighted with pain and humiliation, I wouldn't do it.

[LeftishBrit]

9. I am very sorry about your mother

I agree that quality of life is often more important than quantity. However, I think such decisions should be up to the patient, with advice from the doctor, and not based on the respective financial interests of pharma companies and stingy insurance companies/ governments.

[Liberal Gramma]

13. Good point.

I wouldn't do it, but it should be available to those who would.

[LeftishBrit]

8. And here is a prime example..

of why I always object when people imply that the profit motive inevitably leads to people being prescribed unnecessary drugs, and therefore all drugs/medicine should be suspect. It is just as likely to lead to people NOT getting the drugs they need, as a result of pharma companies over-pricing them AND stingy governments or insurance companies refusing to pay for them. (Or countries being genuinely unable to afford them in the case of the developing world, but that is not the case here.)

[Celebration]

10. like it or not, cost/benefit is implicit in all our decisions

Every time a city or town decides not to put up a crossing guard at a school, or crossbars at a railroad crossing, an economic value is being put on a life. We may not know what particular life will be lost, but we do know that lives will be lost. Yet we elect not to spend the money.

While I understand someone wanting their spouse to live six months longer, even though impaired, would that public health money be better put towards another cause? Public funds are simply not unlimited. Should the cost of the drug be lower? Well, probably. But there will always be treatments that are too expensive relative to the benefit.

[trotsky]

12. Wow, mark this day on the calendar.

You and I are in 100% agreement for once.