Free Market Kills Cancer Patients

[babylonsister]

http://www.boomantribune.com/story/2007/7/14/115741/332

Free Market Kills Cancer Patients

by Steven D
Sat Jul 14th, 2007 at 12:48:26 PM EST

How could that most cherished ideal of capitalism, the "free market" ever do anyone harm? It's the magic bullet, after all, according to conservatives, the engine of all progress, the ultimate hope for mankind. If only big government would get out of its way and let the market work its wonders, the world would be a veritable paradise.

Well, here's how the "free market" works when the lives of cancer patients are at stake, and in particular the lives on non-Hodgin's Lymphoma patients for which two miracle drugs exist which can save lives, if (and how big an if that is will be demonstrated shortly) those afflicted with this killer disease can get access to them (via the New York Times):

After an hourlong infusion, Linda Stephens, 58, has been cancer-free for seven years. Dan Wheeler, three years. Betsy de Parry, five years. Before treatment, all three had late-stage non-Hodgkin’s lymphoma, a cancer of the immune system, and a grim prognosis.

All three recovered after a single dose of Bexxar or Zevalin, both federally approved drugs for lymphoma. And all three can count themselves as lucky. <...>

Non-Hodgkin’s lymphoma is the fifth most common cancer in the United States, with 60,000 new cases and almost 20,000 deaths a year. But fewer than 2,000 patients received Bexxar or Zevalin last year, only about 10 percent of those who are suitable candidates for the drugs.

“Both Zevalin and Bexxar are very good products,” said Dr. Oliver W. Press, a professor at the University of Washington and chairman of the scientific advisory board of the Lymphoma Research Foundation. “It is astounding and disappointing” that they are used so little. The reasons that more patients don’t get these drugs reflect the market-driven forces that can distort medical decisions, Dr. Press and other experts on lymphoma treatment say. A result can be high costs but not necessarily the best care.

Michael Moore, thank you. I doubt the New York Times would have bothered to cover this story until Sicko was released. And this report demonstrates how accurate and timely Sicko has proven to be.

more...

[whopis01]

1. Free markets don't kill people...

People with free markets kill people... um... something like that...

[pstans]

4. Free markets don't kill people, private insurance does.

:shrug:

[bear425]

2. My dad died from Non-Hodgkin's Lymphoma about 5 yrs ago.

I wonder if these drugs were available then? I still feel his doctor could have done much more for him. I miss my dad so much.

[mcg]

3. My younger brother died from it, the HMO initially told him it was bronchitis,

around one to two weeks later he dragged himself there and
had to demand that they help him, he almost died right then
of a massive amount of fluid around his heart.

The HMO was Kaiser Permanente.

I remember seeing a man picketing outside of KP with a sign that said
Kaiser Permanente killed my wife.
They said it wasn't a brain tumor.

Michael Moore Sicko Clip about Nixon and HMOs
http://www.youtube.com/watch?v=kiEVtxGtBqI

February 17, 1971 5:23 PM
Conservation between Ehrlichmann and Nixon at the White House:

Ehrlichmann:
"We have now narrowed down the vice president's problems
on this thing to one issue, and this is whether we should
include these Health Maintenance Organizations like
Edgar Kaiser's Permanente thing."
Nixon:
"Now let me ask you. You know I'm not too keen on any of
these damn medical programs."
Ehrlichmann:
"This is is a private enterprise one."
Nixon:
"Well that appeals to me."
Ehrlichmann:
"Edgar Kaiser is running this Permanente deal for profit,
and the reason he can do it, I had Edgar Kaiser come in,
talk to me about this, and I went into some depth,
all the incentives are toward less medical care,
because the less care they give them, the more money they make,"
Nixon:
"Fine."
Ehrlichmann:
"and the incentives run the right way."
Nixon:
"Not bad."

THE NEXT DAY, February 18, 1971
Nixon on TV telling the American people:

"I am proposing today a new national health strategy.
The purpose of this program is simply this.
I want every American to have the finest health care
in the world and I want every American to be able to
have that care when he needs it."
blink blink blink blink blink blink blink blink

[Igel]

5. Oddly, had they quoted more it would have been less black and white.

I read this the day the NYT published it and didn't want to take the time to unmuddle things.

1. "The drugs have not been clinically proven to prolong survival, compared with other therapies. But patients are more likely to respond to them than standard treatments, and trials to test whether the drugs do have a survival benefit are nearly complete."

In other words, while there's benefit, it's not clearly noised about how much more effective they are--doctors are supposed to rely on prelimary results from the trial (and if they're wrong, they're on the hook for malpractice). "Dr. Connors said that Idec and Corixa should have designed their clinical trials to prove — not just suggest — that the drugs increased survival." In other words, it makes sense that since "... most oncologists outside academic hospitals treat many different cancers (they) may be only vaguely familiar with the drugs...." True, it's a market factor--spreading the word, that is.

I'd note that one of my wife's siblings has bipolar disease. The medication prescribed for one of them was completely useless--they'd tried half a dozen things to no avail. My wife went on the Internet and to the library to do some research, interlibrary loaned articles from physiology and medical journals. There was a compound investigated briefly maybe 30 years ago that had good preliminary results, but the tricyclics were just coming out and were, to put it mildly, a thousand percent better for 95% of suffers. This drug was cheap and readily available, but was never fully investigated because there was no money in it--there were 5% that the other drugs didn't help, but only 1-2% were helped better by this stuff than other, older drugs. But my wife had me scan all the info on the drug, e-mail it to him, and have the doc check it out. The doctor essentially shrugged his shoulders and wrote the prescription out--it had to be compounded to order. That was over a year ago; it worked fine. But the doctor wouldn't have looked for it. As my old advisor used to say, You can't know everything.

2. "Because they are radioactive, they are almost always administered in hospitals, not doctors’ offices. As a result, doctors are not paid by Medicare and private insurers for prescribing them, as they are when they give patients a more common treatment, chemotherapy."

Personally, I think the reporter got it wrong, check out 'give' in the one clause that's parallel to "prescribing". Writing the prescription would still require an office visit. But *administering* the drug (as my sister-in-law's doctor does) wouldn't be the doctor's job.

Even for oncologists, it's still not a great income source: "For most oncologists, infusions of chemotherapy, Rituxan and other drugs are still their primary source of income."

In other words, if the doctor doesn't see the foot-traffic, he doesn't get the payment. Medicare or not. The only alternative would be to simply put doctors on the payroll--not single payer, but actually having the docs as state/federal employees. See 2 patients a week, see 200 patients a week, no matter. This will change, no doubt, but it's a grassroot's level kind of free market, the same kind that makes your mechanic suggest a brake shoe change when you could go a few more thousand miles on it--he'd get the work, and if you wait he might not.

3. It's complicated to administer. One preliminary dose, one larger dose, with frequent monitoring--all coordinated between your doctor and your oncologist. “The doctors looking after people tend to turn to tools that they themselves know how to use and are familiar with."

I had a tendon nodule a few years ago. The appropriate treatment is a cortisone shot next to the nodule. Doc said 'no'--he'd never done it before--and was going to refer me to another doctor who'd try the same things that hadn't work and wait another month or two to do the procedure. He guy only relented when I told him to just give me the needle, the textbook, and the cortisone, I'd do it myself. Five minutes later he had the textbook open, reading it step by step as he gave me the shot. Middling-old dog, new trick.

4. It's radioactive and has to be in the patient's body. I know people that would wait until their health deteriorated far too much before risking it. As with nmri, that *n* was a buzz-kill. It became much more popular as 'mri'.

Now, there *is* a real critique in free-market medicine buried in it all. "Advocates for the drugs worry the companies may stop making them." This has been the case with a number of drugs that have limited use in the 1st world, but which are life-savers in the 3rd world.