A matter of life and death

Thursday, a virtually unnoticed article in the New York Times described enthusiasm in the medical community over new applications of the colon cancer drug Avastin, which can be used to extend the lives of breast and lung cancer victims as well. But, the paper noted,

[D]octors are cringing at the price the maker, Genentech, plans to charge for it: about $100,000 a year...

"Avastin is a superb drug, but its cost is already discouraging patients and doctors from using it," said Dr. David Johnson, who heads the cancer unit at Vanderbilt University and is a former president of the American Society of Clinical Oncology. "I wish it were one-tenth the cost, and if it were I would be giving it to almost everybody."

Because Genentech is a leading developer of cancer therapies, some doctors also fear that the company's pricing plans for Avastin... may encourage other companies to charge more for their own oncology drugs. That could potentially drive up the overall cost of cancer treatment to unsustainable levels, they say.

Maybe it's just me. But I find this to be one of the more important stories of the year, not so much for the specifics of this one case, per se, but for the blatant, exclusionary, arrogant escalation of what is most definitely a class war in our health care system.

Ahead of the pack (as usual) on this issue, Star A. Decise of The Enigmatic Paradox defined the battle lines in this war with an incisive analysis yesterday. Excerpts:

The company's decision on how to price the drug is nothing less than revolutionary, an extraordinarily radical change in the basic economic and philosophical assumptions that have long defined the debate about the costs of American health care. The pricing judgment raises the most challenging questions about equality and society, how we ration health care and how we value life.

Until now, drug manufacturers have typically defended even the most exorbitantly expensive drugs by claiming they reflect the staggering expense of developing and testing new medicines.

Genentech and its majority owner, Roche, have jettisoned that reasoning and are using a completely different argument - the inherent value of life-sustaining therapies... Put more bluntly, that's a way of saying, we can keep you alive: how much is it worth to you to stay alive - for a month, a year?

The unspoken secret of American medicine always has been that it's rationed based on money. Rich patients receive better treatment by better doctors at better hospitals than poor people. The rich get more care and have better access to newer, more effective drugs and technologies.

Now Genentech is, in effect, saying the rich deserve to live not only better but also longer. It's akin to arguing there should be a more lenient judicial system for rich defendants.

But such a revolutionary change in the country's fundamental approach to the very notion of equality and fair treatment shouldn't be slipped into the fabric of American life without careful scrutiny and public debate. It's a dilemma that confronts us all and will only become more pressing as scientists discover new life-sustaining drugs and treatment and invent ever more expensive technologies.

Don't get me wrong. I personally think the geniuses who discover or invent life-saving medicines deserve the world's highest accolades - and some serious coin, which is the primary way human societies have feted their most innovative individuals historically.

So, as a pragmatic inhabitant of the real world, I expect to pay a reasonable amount for those beneficial advances in medical treatments and technologies. And I expect that my insurance carrier will be a reliable partner in helping to defray those reasonable costs, honoring the ethical contract into which they've entered with me each time they cash one of my checks. Good God, man, (harrrumph), we are not Communists!

But neither of those scenarios exist in the Avastin case. Can we as a culture accept that thousands of cancer sufferers who could be helped are now being held hostage by pharmaceutical terrorists, tortured by the existence of a relief held just beyond their reach, extorted by the drug industry into making a choice between death and financial ruin.

If this openly profit-motivated stance by Genentech does, as Ms. Star warns, signal a seismic shift in corporate attitudes toward "how we ration health care and how we value life," we should all be alarmed - and mad as Hell. These attitudes cannot be allowed to pervade the health care industry, even if that requires government intervention on behalf of the general populace.

After all, this Administration has been quite cozy with the health care industry. It's now time that we insist on some representation of our interests for a change, from the only entity powerful enough to influence the medical and pharmaceutical establishment. This level of price gouging, and the offensive rationale behind it, has to be nipped in the bud. Capitalism is one thing, kids. Profiteering is quite another.

What we have here specifically, because this is a health issue, is a basic refutation of the Hippocratic Oath, a mutation of "I will treat without exception all who seek my ministrations" into "What's it worth to ya to live, bitch?" Taken to a logical extreme, the effect of this line of thinking on our access to existing medical remedies is truly frightening. Is it really such a stretch to imagine:

• You need an over-the-counter cough suppressant for your 6-year-old at 1:00 AM. At the only open store in your area, you hand the medicine bottle to the cashier, who smiles sheepishly and says, "Seventy five dollars, man. Sorry, but after Twelve the company figures that it's worth more to parents, so the price goes up."


• You're on your way to the hospital in the back of an ambulance after an auto accident. Just before the EMS technician gives you a shot of morphine for the excruciating pain in your back, she explains that there's a $2,500 surcharge for pain medication during an emergency setting, since it's of greater value to the victim in an unexpected situation. "Do you want me to proceed?" she says sympathetically.


• You've gone to your rural pharmacy for a Plan B emergency contraceptive tablet. But despite the fact that it's a legal drug that does not abort an existing fetus, the corporation that owns your local pharmacy refuses to sell that product, weighing its "value to the community" against subjective moral beliefs. You now have to choose between losing half a day's pay by driving to the next town for the drug, or simply taking your chances an- oh, wait. That's already happening.

Today's Times does have an editorial criticizing the apparently arbitrary and greedy pricing by Genentech, but to me it glosses over the broader implications of this issue that could seep into all aspects of the health-care industry if left unchecked. The article seems to ultimately minimize the situation because of the drug's short-term efficacy and the contention that insurance invariably picks up most of the tab. Sadly, the Times almost endorses the attitude it initially criticized by concluding, "A year of added life of reasonably good quality might be worth a lot to some patients."

Isn't that precisely the position Genentech is taking?

No one should be forced to put a price on his or her life, at least not one which automatically excludes the majority of the population from receiving a beneficial, available drug or treatment. How unbelievably cruel to dangle the prospect of 5 months or a year of extra life in front of a dying cancer patient, only to tell that individual that because of the "value of this medicine to society" - and the case by case ability of insurers to refuse coverage - the cost of that available medicine is simply out of reach.

Bye now. Have a nice day. May as well cancel that family reunion you had planned for the fall.

And that's the best case scenario. For the tens of millions of uninsured Americans whose ranks are growing every day in our "booming" economy, there simply are no options from the very start. And if this "What's it worth?" philosophy does trickle down, unopposed and unchecked, into all areas of pharmaceutical products and medicinal treatments, the poor and middle class will face an increasingly bleak future as more and more medical advancements become available solely to the rich.

We should all be profoundly disturbed by Genentech's defiant stance, and insist on a critical pronouncement of principle from our government. Perhaps this is the pivotal time at which we must decide, as a nation, whether health itself will become a commodity, controlled by corporate interests and sold to the highest bidder, or if it will be the right of all people who are citizens of the wealthiest country on the planet.

It's up to our political leaders, in large because of their incestuous corporate ties, to make a clear statement to the American people defining the type of access to medical treatment - and health in general - we should expect under this and future Administrations. But if there is no significant effort made to address this inexcusable example of the "wealth-based health care philosophy", then the government is sending a clear message to each of us:

"Only the strong (and connected) will endure."

"To the victor (at the NYSE) go the spoils."

"Excel (in filling your bank account) or die."

Sounds a lot like "Survival of the fittest." And for an Administration that opposes Darwinian Theory so adamantly, that would be an extremely curious position to take.