Cancer Ain’t No Moon Child

British medical journal, Lancet Oncology, issued a report about the rising number of cancer diagnoses and the escalating cost of treating patients in the developed world for that dread category of diseases. “Some 12 million people worldwide are diagnosed with cancer each year and that number is expected to rise to 27 million by 2030… The cost of new cancer cases is already estimated to be about $286 billion a year, with medical costs making up more than half the economic burden and productivity losses account for nearly a quarter, according to Economist Intelligence United data cited in the report.” Huffington Post (Reuters), September 26. Given the rapidly escalating cost of cutting-edge treatments and pharmaceuticals aimed at curing or controlling cancer, the possibility is not too far off that we can no longer afford to keep a sizable number of such patients alive without bringing down the entire healthcare system.

“With costs ballooning, a radical shift in thinking is needed to ensure fairer access to medicines and address tricky questions like balancing extra months of life for patients against costs of a new drug, technology or care plan, they said… ‘The cancer community needs to take responsibility and not accept a sub-standard evidence base and an ethos of very small benefit at whatever cost,’ said a report commissioned by the Lancet Oncology medical journal on the costs of cancer care… ‘There should be fair prices and real value from new technologies.’” Huffington Post. For older patients, where treatment might add a few months or even a year or two of life, often with great discomfort, should they be afforded these expensive treatments? If they really want these treatments? And if so, who gets to pay for it? But if only rich can afford such a life, is that really fair?

“Prices for some of the latest experimental drugs unveiled at the EMCC -- including a highly-sophisticated armed antibody drug from Roche and a so-called alpha-pharmaceutical from Bayer and Algeta -- are likely to reach into the tens of thousands of dollars per patient…The Lancet report pointed to Dendreon's Provenge prostate cancer treatment -- which costs more than $100,000 for a three-dose course and was found in trials to improve survival by several months in patients with few other options… ‘How should we determine its value?’ the report asked.

“Michael Baumann, president of the European Cancer Organization, said there was an ‘explosion of new possibilities’ in cancer treatment and care. This was exciting for scientists, oncologists and cancer patients, he said, but also made it ‘absolutely necessary to think about this cost issue now.’” Huffington Post. That’s where folks have insurance, but there are a whole pile of Americans who believe that their fellow citizens who aren’t willing to pay for healthcare (or who cannot get healthcare) should be left to die in times of dire need. The Los Angeles Times (September 13^th) presents this summary of one segment of the September 12^th GOP presidential candidates’ debate: “Healthcare, and the role of a strong central government in providing it, is one of the key issues separating the GOP, which opposes Obama’s healthcare insurance overhaul. So it was no accident that the issue became part of the debate as host Wolf Blitzer posed a hypothetical to [candidate Ron] Paul [pictured above], who is also a physician.

‘A healthy, 30-year-old young man has a good job, makes a good living, but decides: You know what? I'm not going to spend 200 or 300 dollars a month for health insurance, because I'm healthy; I don't need it,’ Blitzer said. ‘But you know, something terrible happens; all of a sudden, he needs it. Who's going to pay for it, if he goes into a coma, for example? Who pays for that?...‘In a society that you accept welfarism and socialism, he expects the government to take care of him,’ Paul replied. Blitzer asked what Paul would prefer to having government deal with the sick man.

‘What he should do is whatever he wants to do, and assume responsibility for himself,’ Paul said. ‘My advice to him would have a major medical policy, but not before —… ‘But he doesn't have that,’ Blitzer said. ‘He doesn't have it and he's — and he needs — he needs intensive care for six months. Who pays?’… ‘That's what freedom is all about: taking your own risks,’ Paul said, repeating the standard libertarian view as some in the audience cheered…. ‘But congressman, are you saying that society should just let him die,’ Blitzer asked…. ‘Yeah,’ came the shout from the audience. That affirmative was repeated at least three times. Paul, who has always had a reputation for being a charitable man, disagreed with the idea that sick people should die, but insisted that the answer to the healthcare problem was not a large government.

‘I practiced medicine before we had Medicaid, in the early 1960s when I got out of medical school,’ Paul said. ‘I practiced at Santa Rosa Hospital in San Antonio. And the churches took care of them. We never turned anybody away from the hospitals. And we've given up on this whole concept that we might take care of ourselves and assume responsibility for ourselves, our neighbors, our friends; our churches would do it. This whole idea — that's the reason the cost is so high. The cost is so high because we dump it on the government. It becomes a bureaucracy. It becomes special interests. It kowtows to the insurance companies, then the drug companies.’”

Tough moral issues, and who needs “death panels” when you automatically condemn someone to death by virtue of their age or insurance status? What exactly is the right answer in a society that cannot afford to treat everyone, and where not everyone can afford to have the coverage that might save their lives? Or might be too young and too stupid to have learned that life’s lesson. And what about preexisting conditions and lifetime insurance policy limits?

I’m Peter Dekom, and a society with dwindling economic resources is simply going to have to make some of the most difficult moral decisions of its existence….