Thursday, April 29, 2010

Health Care Costs

The costs of health care continue to rise.

Much of the blame for this is placed on the insurance companies, pharmaceutical giants, and individual health care givers who all seem to put profits above a patient's health.

It wasn't that long ago that Barack Obama, himself an unrepentant smoker, criticized the medical profession for coaxing unwary patients into too many needless medical procedures. And, I suppose, not one of his personal physicians has ever urged him to quit smoking and to watch his cholesterol.

Today the pharmaceutical company Dendreon received FDA approval of its prostate cancer vaccine Provenge.

The new vaccine, Provenge doesn't prevent cancer, unlike the polio shot or recently approved vaccines that block infection with viruses that cause most cervical tumors. Provenge, which will cost $93,000, also doesn't cure cancer.

But studies show that the vaccine does help men with advanced prostate cancer live four months longer than men given placebo shots, says Philip Kantoff of Boston's Dana-Farber Cancer Institute, primary investigator of a study of 512 men.

After three years, 32% of men given Provenge were alive, compared to 23% given a placebo shot, Kantoff says. That's a significant benefit for men with such advanced disease, who would otherwise live only about 22 months, Kantoff says.
It has taken Dendreon years to get FDA approval for their new treatment with early clinical information released nearly a decade ago. Since that time numerous clinical tests have been done and the company's prospects for survival have risen and fallen with the vaccine's perceived future.

Provenge is genius. It helps represent a new generation of medical discoveries that are manufactured for a specific individual. The Provenge treatment is a process that begins with the extracting of a patient's own blood cells and then incubating them with the Dendreon fusion protein. (I don't pretend to understand this...) The vaccine is administered in a series of three shots.

The cost of $93,000 is visually stunning particularly when it appears to buy only an intermediate step toward an ultimate cure.

With FDA approval now in hand, who can we expect to receive the $93,000 treatment? Certainly any man suffering with prostate cancer would like to be among the recipients. Should the treatment be made available to every man with Medicare and Medicaid? Should the government make it mandatory that this new vaccine be administered to any candidate sufferer with private insurance? Or should only those individuals who have the ability to pay out of pocket be able to extend their lives?

These are moral questions that I'm not even going to enter into.

The important thing to note is that it is the enormous sums of money in the aggregate health care system, from the investors who front the capital for medicines with no hope of a short term return on investment, to the astronomical expenses associated with a demanding FDA and clinical trials, that have taken prostate cancer from a certain short term death sentence onto the threshold of hope.

Many more years ago than she would like you to realize, my sister was born at St. Luke's Hospital in Marquette. (This was waaaaay before I blessed the world.) Ten days in the hospital for mother and child, the delivery room fee, medicine, dressings, and laboratory came to a whopping $62.50. This was in the days before sonograms, MRIs, pacemakers, quadruple bypasses, and, incidentally, back when the diagnosis of leukemia came with a death certificate.

Medical care costs a lot these days, but these increases are not solely the fault of evil dabblers trying to make a buck off the poor soul who just developed a cough. The same system that brought us greedy insurance companies, lecherous big pharma, and selfish country club doctors also happens to be the same system that just today delivered to prostate sufferers the hope of Provenge.

How much is hope worth?

1 comment:

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