The ASCO Post | MAY 1, 2011
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Opinion Policy
Health-care Economics continued from page 1
research and applying compassion will save more lives, bring greater comfort to our patients, and bring greater satisfaction to our professional lives.
Wrenching Decisions But how can our society pay for the scientific discoveries that may lead to cures, prolongation of life, or simply a slight delay of death? Like so many wrenching decisions being considered in the face of our nation’s debt, we need to consider economics when health care becomes too expensive and crushes other societal needs. And how shall we pay for the short- or long-term therapies, the potential cures, and the desired preventions? Should economics be further introduced into the decisionmaking of the care we render? If a patient and family were told that a therapy being offered has a 50% chance of prolonging life by 2 to 4 months, would the patient endure the further care? If that care were to cost the patient or his/her future estate $100,000, would that alter the decision? For patients who can afford such therapy, perhaps on a sliding scale, should society be asked to fund it, essentially funding the monies passed down to the patient’s heirs? At what point does society state that decisions impacting the economics of health care are no different than those involving the economics of other aspects of life? Where clinical studies have proven that a therapy (medication, radia-
tion, or surgery) clearly prolongs a quality productive life, particularly in the young, society should provide the care when insurance is not adequate. However, when the treatment is limited in its ability to improve life, the patient and his family should consider all the implications.
The Financial Burden on Family I will never forget the elderly patient with widely metastatic prostate cancer who came into my office with his wife of 50 years. He had Medicare, but no other insurance. He was
with his decision. Considering that a significant amount of one’s lifetime health-care expenditure occurs in the last year of life, and that there is not a limitless amount of money, personal healthcare economics may need to be considered as our nation struggles with controlling the debt.
The Impatient Patient Whether we are in research, clinical care, or both, our goals are to provide the best care for our patients. There is no reasonable method of determining whether a discov-
Scientists often say that one cannot predict what small finding will lead to major changes, and that is true. But there are limits to the logic, and with limited funds and a crushing debt, one must use common sense. faced with the decision of whether to continue his depot LHRH agonist because of the co-pay of several hundred dollars. He tearfully said that he could no longer live with the idea that the medication may prolong his life a few more months, but he believed his memory would be sullied in his wife’s mind because she would have less money to live on when he was gone. I tried to dissuade him and spoke to the manufacturer about obtaining the medication on a compassionate care basis, and the company responded favorably. The patient refused the medication, however, and he died soon thereafter satisfied
The ASCO Post (ISSN 2154-3283) is published semi-monthly, except monthly in February, April, June, August, October and December, by Harborside Press, 37 Main Street, Cold Spring Harbor, NY 11724, under a license arrangement with the American Society of Clinical Oncology, Inc. (ASCO®). Application to mail at Periodicals Prices is Pending at Cold Spring Harbor, NY, and additional mailing offices. Change of Address: Postmaster send address changes to The ASCO Post, c/o Harborside Press®, 37 Main Street, Cold Spring Harbor, NY 11724. ASCO Members: If you would like to cancel your subscription to The ASCO Post or need to update your mailing address, please visit your personalized page on ASCO.org. For personalized service, please contact ASCO Member Services at (888) 282-2552, (703) 299-0158, or via email at membermail@asco.org. Non ASCO Members: To initiate or cancel a subscription or to update your mailing address, please email wendy@harborsidepress.com or fax (631) 692-0905. Copyright ©2011 by Harborside Press®, LLC. All rights reserved. Reproduction in whole or in part, in any form, without prior written permission of the publisher is prohibited. For permission inquiries, contact permissions@harborsidepress.com. Editorial Mission: The ASCO Post communicates timely information to a broad audience of oncology specialists, helping to advance the highest quality multidisciplinary cancer care. The ASCO Post publishes highly validated coverage of cancer research and policy news, patient care and clinical practice issues, and thoughtful commentary from leaders in the field and others with an interest in clinical oncology. Circulation: The ASCO Post is sent free of charge to approximately 26,000 physicians and nurses, including all US-based ASCO members. Medical, surgical, pediatric, and gynecologic oncologists, hematologists, and hematologist/oncologists in the United States who are not members of ASCO will be eligible for a complimentary subscription. ASCO members outside of the United States receive complimentary access to The ASCO Post online at www.ASCOPost.com. Paid subscriptions to The ASCO Post are available for all other interested individuals. Individual Domestic: $225; Individual International: $275; Institutional Domestic: $275; Institutional International $350. Contact subscriptions@harborsidepress.com.
ery will lead to a cure, or better and longer health for patients. So the pursuit must continue with greater energy, enthusiasm, and funding. That is critical. The public has been convinced of the primacy of science and the real value of research. Our nation has made the decision to fund biomedical research at the expense of other less valued services and industrial output. But there seems to be a limit, and the ultimate consumer, the patient, is getting impatient. Some Americans believe that they are not getting their money’s worth. Science for the sake of sci-
ence may be peaking in its perceived value. Application and translation of science for the betterment of health has begun to take hold of the political (and the kitchen table) discussion. Is the country improved by funding remarkable discoveries that will have no chance of improving anyone’s health? Scientists often say that one cannot predict what small finding will lead to major changes, and that is true. But there are limits to the logic, and with limited funds and a crushing debt, one must use common sense.
Consider Risk-sharing Thus, we must continue advancing the discoveries, the exciting science, the exhilaration of lighting the darkness of the unknown, but we should consider risk-sharing. If projects are worthy and show the promise of translating into long-term therapies, preventions, or cures, the nation must promote them. But those who benefit—whether businesses or patients—and have the means must also be willing to cover the cost through risk-sharing, direct payment, or probate.
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Financial Disclosure: Dr. Boxer reported no potential conflicts of interest.
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