Medicynic

Value in medicine appear to be an oxymoron. Despite having little evidence of efficacy but strong evidence of great cost, the National Comprehensive Cancer Network (NCCN) an ad hoc outfit that provides guidelines for cancer treatment has decided that Avastin should be available to treat cancer patients.

Apparently $80,000-$90,000 for treatment, for the drug alone, does not make them pause even a second on their recommendation.

Of course a significant number of the panel members who decided this, including the chairman are on Genentech/Roche’s payroll. (FYI Genentech/Roche makes Avastin)

The organization’s “quote” conflict of interest rules state:

Per NCCN policy (also on the website), disclosure of a relationship with an external party does not automatically disqualify an individual from committee membership.

The policy also states that committee members who have a “significant and direct or indirect interest with an external entity which constitutes a conflicting interest shall not participant in the NCCN Guidelines Panel’s discussion when the NCCN Guidelines Panel’s action or topic under discussion may advantage or disadvantage an external entity.”

However, the NCCN disclosure policy gives committee chairs discretion to allow panelists with potential conflicts to “participate for the purpose of providing or presenting information to the NCCN Guidelines Panel.”

Medicynical Note: Cost-efficacy doesn’t appear to be anyone’s responsibility. No wonder our non-system of health care is the most expensive by far in the world.

And no wonder our dysfunctional pathetic political non-system which oversees health care (as well as our national budget and debt “ceiling”) is the laughing stock of the world.

This chart tells it all. Republicans had no problem with Bush but are determined to continue our recession/depression and health care by by cutting programs that benefit the poor, lower middle class, the sick and infirm the most. It’s letting them eat cake.

The Boehner bill to be voted on today will cut 1.6 trillion from “entitlements” which will include cuts in Medicare, Medicaid and Social Security. Meanwhile his party has vowed there will be no increase in taxes on anyone, including the weathiest individuals and corporations. Just to refresh your memory in the US the distribution of wealth is highly skewed to the wealthiest and has gotton more out of balance the last ten years:

Top 1% own 38.1%
Top 96-99% own 21.3%
Top 90-95% own 11.5%
And it gets much uglier as you proceed downward. Bottom 40% of population has 0.2% of all wealth.

Medicynical note: The cuts proposed by Boehner, the tea party, and the republicans in Medicare and Medicaid will result in much pain, suffering and deaths in the lowest income groups who cannot afford healthcare and rely on publically funded programs. Yes people will die.

We can and should do better by implementing health reform; providing rational coverage to the uninsured; controlling costs by evaluating treatment options and using the most cost effective; negotiating with suppliers on price; cutting the cost of administration.

Drug companies take advantage of chronically ill patients and their families by aggressively marketing modestly effective drugs at inflated prices, especially in the U.S. This is commonplace for cancer patients who are coerced into paying $50,000-$100,000/year for drugs offering very limited benefit.

The same appears to be true in multiple sclerosis:

The drugs include beta interferons (brand-names like Avonex, Rebif and Betaseron), glatiramer (Copaxone) and natalizumab (Tysabri). They are given by injection or infusion and can help prevent MS symptom flare-ups and delay long-term disability from the disease. But the price tag is large, with each drug now costing upwards of $3,000 a month in the U.S.

And a study in the journal Neurology estimates:

They would gain an extra two months or less of good health over 10 years, the researchers say, compared with using only therapies that help ease MS symptoms — like medications for pain, fatigue and muscle spasms. Overall, the study estimated, DMDs cost close to $1 million for each year of relatively healthy life a person with MS could expect to gain with 10 years of use.

And if the drug is started earlier in the course of the disease:

The researchers estimate that starting the drugs before any noticeable disability makes the medications more cost-effective — though they still hover above $700,000 for each good-quality year of life gained.

It should be noted that while there is no hard and fast rule regarding cost-effectiveness in the U.S., costs exceeding $150,000 for a year of good quality life are consider excessive. Consider also that the average and median incomes in the U.S. are in the $50,000-$60,000 range.

And in the U.S. we get to pay more for the drugs!

Both Noyes and Smyth said the findings highlight a wider issue: the high price Americans pay for prescription drugs.

Avonex, for example, cost Americans with MS about $34,000 for the year in 2010. The price in the UK was equivalent to about $12,000 — because that’s all the National Health Service will pay for the drug.

Medicynical Note: Is it any wonder the PHarma doesn’t want to negotiate prices with Medicare and pays our congressmen and women handsomely in the form of campaign support to maintain the pricing structure in the U.S. It may be “speech” of some sort, but it certainly isn’t free.

A a graph says it best:

The NEJM reviews the limitations of Medicaid, which is about to get worse whether or not there is agreement on debt extension:

Medicynical note: This in the “best” and most expensive non-system of healthcare in the world.