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Publicado el 03-25-2011
Reportero: Grace-Marie Turner

Rationing Hope

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Grace-Marie Turner

Great Britain’s national health agency late last year reaffirmed its decision to deny the breakthrough drug Avastin to patients with advanced breast cancer. Just days later, the U.S. Food and Drug Administration (FDA) followed suit, denying treatment -- and hope -- to the 17,500 American breast cancer patients prescribed Avastin each year.

This is a sign of things to come. Under the new health overhaul law, far too many medical decisions will be made by bureaucrats -- not doctors and patients.

The British agency was at least open about its decision, saying that “the benefits offered [don’t] justify the cost the NHS is being asked to pay.” The FDA, which only has statutory authority to make decisions based on safety and effectiveness -- not cost -- said that the drug didn’t provide “a sufficient benefit in slowing disease progression.”

The thousands of women with terminal breast cancer who have lived on months or even years of borrowed time thanks to Avastin would beg to differ.

To government bean counters, Avastin’s $88,000 yearly per-person cost is a very compelling reason to find its benefits insufficient to justify coverage. The ability to see your child graduate from high school or walk down the aisle is the sort of sufficiency that only matters to dying cancer patients, their families, and the doctors who treat them.

And, hope? It has no place in the sterile analysis of rationed health care.

Who defines what benefits are “sufficient”? Will it be patients and doctors -- as has been the American tradition? Or will it be bureaucrats?

In Britain, the government-heavy model has produced far lower survival rates for breast cancer. Lancet Oncology, the prestigious medical journal, reports that 84 percent of U.S. women live at least five years after breast cancer diagnosis. Only 69 percent of British women survive as long.

Does Avastin have awful side effects? Yes. But, patients and doctors should be the ones to evaluate whether those side effects are a risk worth taking.

Once the FDA finalizes its withdrawal of Avastin for advanced breast cancer, doctors will still be able to prescribe the medicine for “off-label” use.

But off-label prescriptions are rarely covered by Medicare or Medicaid, and private insurers typically take their cues from their public counterparts. Terminal breast cancer patients would have to pay the full cost of the ...
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