Academic journal article The Hastings Center Report

Starve Them or Shoot Them

Academic journal article The Hastings Center Report

Starve Them or Shoot Them

Article excerpt

Starve Them or Shoot Them

It finally happened. Two weeks ago a senior vice president from a major pharmaceutical company called me up.

"Lee," he said, "I have a problem I need your advice on. It's sort of a cost and quality problem," he said hesitatingly, "and I don't quite know what to do about it. I thought with your knowledge...."

"Fine," I said, nestling into my chair. "Let's hear it."

"Well," he said, "the good news is that we've got this new drug that's just great for prostate cancer. The literature suggests that patients live about seven months longer when it's used in combination with several other old-line therapies."

"Sounds great," I said. "What's the problem?" "The problem is the cost," he said. "Ah," I thought. "Here we go again. Another high-priced drug that the insurers will refuse to pay for, because it's not on the FDA label as an indication for use." But I was wrong.

"Actually," he said, "We've priced it pretty reasonably. In fact, month for month our therapy is lower in cost than the current therapy. So I've presented a proposal to three different insurers and, the upshot is, they don't want to pay for it."

"I don't get it," I said, hoping I didn't.

"The deal is this," he said. "The total cost of our treatment is higher, because the patient lives longer."

Now I've thought about this conversation for the last two weeks and mulled over our options. As I see it, we have four standard options:

Option #1: Accept defeat. This option used to be the last option on the list, but as I see more and more medical oncologists who are exhausted from fighting the same battles over and over again, I can see it becoming the #1 option. Sometimes the dragon wins.

Option #2: Prepare to do battle. This is the option where we all put on the family armor (which is badly dented from multiple battles with dragons from the Office of Technology Suppression), rally the troops, remount our horses, and charge the monster again. …

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