SciTech

How Much Is Too Much For Your Life?

port1080.

Posted to SciTech on Thu Mar 27, 2008 at 02:54:11 AM EST (promoted by 1fastdog). RSS.

The American Society for Clinical Oncology is preparing new guidelines for treatment which will, for the first time, include a discussion of cost considerations for advanced treatment options. The lack of universal health care in the US, combined with skyrocketing costs, has pushed this issue to the forefront for patients facing a terminal cancer diagnosis.

According to the article:

The prices can be staggering. Consider: There are two equally effective options to battle metastatic colon cancer, the kind spreading through the body -- but one costs $60,000 more than the other, says Dr. Leonard Saltz of Memorial Sloan-Kettering Cancer Center.

What's the difference? The cheaper one, irinotecan, causes hair loss that makes it impossible for people trying to keep a job to hide their cancer treatment, he explains. The pricier oxaliplatin can cause nerve damage in hands and feet that might make it a worse option for, say, a musician or computer worker.

Saltz offers a tougher example: A drug for pancreatic cancer -- an especially deadly cancer with few treatment options -- can cost $4,000 a month. Yet while Tarceva has offered some people remarkable help, research suggests that extra survival on average is a few weeks.

"Is it a good investment, a high-risk investment, or buying a lottery ticket?" is how Saltz puts these choices.

Of course, this problem is not just limited to the US. Many countries with universal healthcare systems must also face similar problems, as cash strapped programs must decide whether it makes sense to pay for drugs that may extend one person's life for a few weeks with a cash outlay that would pay for cheaper and slightly less effective drugs for a hundred people at the same cost.

Some Americans on public assistance have already seen this sort of bureaucratic rationing - the article notes that:

When Medicare began its Part D prescription coverage, retiree Helen Geiger of Whiting, N.J., paid for a premium plan and put it to good use when she was diagnosed with multiple myeloma, a blood cancer. She said the plan listed the cost of her dose of Thalomid at $5,500 a month but her copay was $60 a month.

In renewing the prescription plan last year, the 71-year-old Geiger didn't notice that Thalomid coverage had been changed. It now was classified a specialty drug, costing a $1,051 monthly copay that she couldn't afford.

Given the fundamental questions of fairness involved (should accumulated wealth really be what defines the length of a person's life? Should disconnected bureaucrats really be making life or death decisions based on actuarial tables?), is there any good way to resolve this dilemma? The number of life prolonging treatments (and their associated cost) will no doubt increase exponentially in the coming decades, making this a problem that seems unlikely to simply fade away.

Tags: written by Port1080, edited by 1fastdog, healthcare, cancer, money, medicine (all tags)

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1

Don't care about the cost, prove it's effective

joshv.

Thu Mar 27, 2008 at 07:30:41 AM EST

5.00 (astute)

It'd be nice if the medical establishment released some data that proved their treatments effective at saving, or even extending lives.  I'll grant that surgical removal of non-metastatic tumors can be a life saving treatment, but few people escape the US cancer treatment industry without being subjected to some other form of highly toxic treatment.  As mentioned in the article many of these treatments have serious, and often life-threatening side effects, and many can even cause cancer themselves.

Sure, Doctors will quote you improving 5-year survival rates until the cows come home, but this is an artifact of earlier detection, not the efficacy of treatment.  They will also point to the fact that overall cancer mortality is falling in the US, but it's hard to point to a single cause, especially when smoking rates are falling along with exposure to environmental carcinogens.

I recognize that there may be some cancers, and some treatments that are highly effective, but overall, on average, cancer treatment in the US is a hugely expensive endeavor which has never been proven to save or extend lives.

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Re: Don't care about the cost, prove it's effectiv

port1080.

Sat Mar 29, 2008 at 08:41:55 AM EST

none

One thing that sort of bothers me about this whole debate is the notion that most treatments "only offer a few weeks of extra life, at best". Well, maybe so, but how do you put a premium on those few extra weeks? My wife's mother died of cancer when she was in her mid-40s. She had aggressive gall bladder cancer, and she pursued aggressive treatment. I'm sure the treatment only prolonged her life by a few months at best (she only lived a little over a year from when she was diagnosed), but I don't know how you could possibly quantify the value of those few extra months to my wife (& by extension to her mother - even if you argue that that she herself might not have wanted the extra months of pain, I know she would have done anything to spend a little more time with my wife). It's one thing to sit here in the abstract and talk blandly about "a few extra weeks", but when that's all you have left...

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Re: Don't care about the cost

skeptic.

Sat Mar 29, 2008 at 09:59:03 AM EST

none

On the principle that "you can't take it with you" you might easily think that there is no better use for your money than to preserve your own life for as long as you can.  At the same time, people who have terminal diseases are often so sick that they don't enjoy being alive anyway, and would rather die sooner.  I think that the main reason why people get medical treatment even when it is expected to prolong their lives only slightly, is that you never really know, until you do it, how much of a difference it will make.  Sometimes people live far longer than the time than they were expected to.  So, you take a chance.  You have nothing to lose except money.

3

Re: How Much Is Too Much For Your Life?

Steve Urkel.

Thu Mar 27, 2008 at 01:39:25 PM EST

4.50 (astute, astute)

"should accumulated wealth really be what defines the length of a person's life"

Yes. There are always tradeoffs, and the reality is not everyone can have the latest, most expensive treatments. All of us place a different value on our own lives. Some of us smoke, some of us hang glide, most of us spend money on cable TV and hookers that we could just as well spend on supplemental health insurance, because we prefer to enjoy ourselves now rather than go without in order to have our lives extended 6 months when were old.

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Speak for yourself Steverino.

MayorBob.

Thu Mar 27, 2008 at 02:10:04 PM EST

4.66 (funny)

I cut back on my cable TV premium package over money concerns.  But I resolutely refuse to be a skinflint when it comes to hookers.

Illegitimi non carborundum.

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Re: Speak for yourself Steverino.

Steve Urkel.

Thu Mar 27, 2008 at 02:52:03 PM EST

5.00

With age comes wisdom, as they say.

There is the problem of "time horizons", but it's tangential. And then there is flat out stupidity, like the guy I once knew who opted out of his companies health care plan for the small amount of extra take home pay because his motorcycle payments were so high.

2

Re: How Much Is Too Much For Your Life?

skeptic.

Thu Mar 27, 2008 at 12:59:35 PM EST

none

This is a very serious issue.  I think that we would all like to think that human life is so valuable that no dollar amount can be placed upon it, particularly since that is our own subjective experience; every individual normally feels (barring some abnormal depression) that his or her own life is absolutely essential and cannot be given up for any reason.  Human evolution has endowed us with those feelings.  But in practical terms, there is only so much money that a given individual can spend, and there is also only so much money that any given nation can spend for the purpose of helping out individuals who otherwise could not afford medical care that they need.  On a global basis we could also note that the resources of the world are finite, while the demands of the human population are ever-increasing (due both to growing population, and also to the demand for higher standards of living).  At some point it becomes a problem just to keep everybody fed, much less to give everybody the medical care that they need.  

Like many of the dire problems which the world is facing in the 21st century, this one does not have any easy solution.  But certainly, global population control is a good place to start.

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Re: How Much Is Too Much For Your Life?

skeeter1.

Thu Mar 27, 2008 at 08:42:29 PM EST

5.00 (informative)

"This is a very serious issue.  I think that we would all like to think that human life is so valuable that no dollar amount can be placed upon it, particularly since that is our own subjective experience; every individual normally feels (barring some abnormal depression) that his or her own life is absolutely essential and cannot be given up for any reason."

I can speak from firsthand experience here.  I was diagnosed with cancer of the tongue last Spring.  I underwent 3 rounds of cisplatin chemotherapy and 39 rounds of radiation therapy.  Well, my health insurance provider found a loophole (I won't discuss it, so don't ask) and dropped me like a hot potato.  Now I'm sitting on around $100K of bills.  I'm still alive, and functioning fairly well. At least I can eat small amounts of solid food again.  There's nothing like eating a liquid diet (Ensure, et. al.) through a PEG tube to make you appreciate eating anything again.

Where this will all play out for me in the end, I have no idea.  

there's only one way to find out...

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Re: How Much Is Too Much For Your Life?

skeptic.

Fri Mar 28, 2008 at 08:47:49 AM EST

none

I agree, your personal experiences perfectly illustrate the situation we are discussing, of very expensive medical care being needed to preserve someone's life.  (I will also note that I personally do appreciate your contributions to this web-site, so I have reason to be glad that your life was preserved, as well as to regret that you had developed cancer in the first place.)

So, given your personal experience with this problem, do you have any suggestion about what we as a society should be doing about high medical costs?

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Re: How Much Is Too Much For Your Life?

skeeter1.

Sun Mar 30, 2008 at 12:09:47 AM EST

none

"So, given your personal experience with this problem, do you have any suggestion about what we as a society should be doing about high medical costs?"

Were it up to me, I'd suggest a socialized medical system, something like they have in Canada, perhaps England, maybe even Russia.  None of them are perfect, far from it, but they're better than what we have in the US.  

And thanks for the kind words about my little writings.  I do enjoy trying to keep my brain in gear.  

there's only one way to find out...

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