The good news is that there may be a drug that improves, somewhat, the survival of patients with malignant melanoma.
The bad news is that the drug company marketing the drug, Bristol Meyers, is charging $120,000 for a course of treatment, four injections over three months.
In that randomized clinical trial, patients with metastatic melanoma treated with Yervoy lived a median of about 10 months, compared with 6.4 months for patients in a control group, who received a treatment believed to have had little effect.
More than 20 percent of the people who received Yervoy in the trial lived at least two years, and some of them much longer. But there is no way at present to predict which patients will benefit from the drug.
But, always a but:
The drawback is that loosening the restraints on the immune system can lead to dangerous side effects, the most worrisome being colitis and diarrhea, but also hepatitis, endocrine dysfunction and skin problems. The F.D.A. said that 12.9 percent of patients treated with Yervoy suffered severe or fatal autoimmune reactions.
Medicynical Note: The drug in this early study appears to have some efficacy and significant toxicity. Half the patients treated get less than a 4 month survival benefit–if this study’s finding hold up in the future. (It should be noted that first studies often show better results than confirmatory studies)
Can our non-system of care afford a $120,000 drug that improves survival just 4 months? Can 99% of our citizens afford such a drug if insurance doesn’t cover.
The pharmaceutical industry deserves credit for helping develop an drug with some efficacy. But charging 3-4 times the average person’s income/year, takes the pay us or die ethic to a new extreme.
The question is not whether we will ration care by cost to most people but how. It should be understood that whatever the approach we take, republican or democratic, the wealthy will be more able to afford that which is not covered by insurance.
We may have the opportunity in future elections to decide.