Later On

A blog written for those whose interests more or less match mine.

New form of NIMBY: Cut others’ healthcare costs, not mine

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Joe Nocera has an interesting column in the NY Times this morning:

In 1998, The New York Times published a front-page article suggesting that two new drugs, angiostatin and endostatin, might finally win the war on cancer.

Though not yet tested in humans, the drugs had “eradicated” cancer in mice, the article said; and while some researchers were cautious, others could barely contain themselves. Dr. Richard Klausner, then the director of the National Cancer Institute called the drugs “the single most exciting thing on the horizon.”

In the subsequent 13 years, oncologists have come to the sobering realization these new drugs are not the holy grail after all. Usually used in conjunction with chemotherapy, they extend life and suppress tumor growth — but only by months, not years. Sometimes they do less than that — with serious side effects. As a breast cancer therapy, alas, the angiostatin Avastin falls in the latter category.

This is not to say that Avastin doesn’t help cancer patients. For lung cancer patients, Avastin plus chemotherapy extends life by an average of two months longer than chemotherapy alone. For renal cancer patients, Avastin gives the average patient an additional 4.8 months of what’s called “progression-free survival” — meaning that the tumors don’t grow and the cancer doesn’t spread for that amount of time.

But for breast cancer patients, Avastin neither suppresses tumor growth to any significant degree nor extends life. Although a 2007 study showed Avastin adding 5.5 months to progression-free survival, subsequent studies have failed to replicate that result.

As a result of that first, optimistic study, the Food and Drug Administration gave the drug “accelerated approval,” meaning it could be marketed as a breast cancer therapy while further studies were conducted. Those follow-up studies are what caused a panel of F.D.A. experts to then withdraw that approval. That decision, you may recall, was made this summer, after a heated two-day meeting that included pleas from breast cancer victims and enormous pushback from Genentech, which markets the drug and reaps around $7 billion in annual Avastin sales. After weighing the evidence, the F.D.A. panel voted 6 to 0 against Avastin.

After Genentech appealed, Dr. Margaret Hamburg, the F.D.A. commissioner, affirmed the decision on Friday in a ruling that would seem, on its face, unassailable. She essentially said that F.D.A. decisions had to be driven by science, and the science wasn’t there to support Genentech’s desire to market Avastin as a breast cancer drug.

Yet there was an immediate outcry. Some breast cancer patients, convinced that the drug was helping them stay alive, condemned the ruling. That’s certainly understandable. Less understandable was the reaction from conservatives, who cast the F.D.A. decision as an example of the nanny state making decisions that more properly belonged to doctors and their patients. The Wall Street Journal editorial page called Dr. Hamburg’s decision a “blunt assertion of regulatory power” and described Avastin as “potentially life-saving,” which it most certainly is not.

The strangest reaction, though, has come from the nation’s health insurers and the administrators of Medicare. Despite the clear evidence of Avastin’s lack of efficacy in treating breast cancer, they have mostly agreed to continue paying whenever doctors prescribe it “off label” for breast cancer patients. Avastin, by the way, costs nearly $90,000 a year.

The reason they are doing so is obvious: . . .

Continue reading.The column ends:

Conservatives, in particular, insist that Medicare must be reformed. Here is an enormously expensive drug that largely doesn’t work, has serious side effects and can no longer be marketed as a breast cancer therapy. Yet insurers, including Medicare, will continue to cover it.

If we’re not willing to say no to a drug like Avastin, then what drug will we say no to?

He asks a good question: Conservatives are eager to cut government spending, it seems, except for that spending that goes to them personally. “I want mine, to hell with everyone else”: the Conservative marching song.

Written by LeisureGuy

22 November 2011 at 8:30 am

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