Bruce Hardy has kidney cancer that has metastasized to his lungs. Pfizer has a drug shown in clinical trials to delay the progression of the cancer for about six months at a cost of $54,000. The British National Institute for Health and Clinical Excellence (NICE) has determined that six additional months of life is worth only about $22,750, so they have denied Mr. Hardy the drug.
I don't disagree with the British. They seek to ensure medical care is both cost effective and effective. A full course of immunizations for a child costs $1200, so Mr. Hardy's recommended course of treatment is equivalent to vaccinating 45 children. Which is worth more, six months of additional life for a 54 year old man or 45 immunized children?
I disagree with the notion that we can value every moment of every individual's life and make meaningful comparisons with the value we set on another person's life.
I need to look more closely at the mechanics of how value is established, but I have some immediate questions:
Is value based purely upon the economic value of the individual? I believe this is at least partly true in litigation.
How do we reconcile the value an individual places on their life with the value of that life to society?
How do we establish the limit of what we are willing to pay to keep someone alive? Does society have a moral obligation to allow individuals to live as long as possible? Do individuals have a moral obligation to not burden society?
How do we reconcile the profit motive of the health care industry with our obligation to provide for individual's health? How do we keep industry from profiteering, while ensuring that some entity has the incentive to provide quality health care and develop new (effective) medical techniques.
Clearly, I need to perform a great deal of research to answer these questions intelligently (or even to ask intelligent questions.) However, I wanted to at least begin listing some of the public health issues that have been bothering me.
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So often with the treatment of terminal illness such as cancer; it is a roll of the dice toward an uncertain outcome. Uncertain if the outcome will be complete recovery followed by a long period of health, a partial recovery for a short time before falling back into a more serious and painful phase of illness resulting in death, or no recovery at all.
ReplyDeleteMy brother died from cancer last December and when he was first diagnosed he asked for my counsel on how to proceed. We talked at length and both met with the oncologist who was trying to paint a very rosy picture of his chances for full recovery; something that when we did our own research on his illness, the statistics simply did not support. He asked me point blank based on the facts at hand if I would pursue treatment if I were in his situation and I honestly answered that I would not. Mainly because the odds appeared to be too long and the costs too great. The oncologist reacted with anger and said it was a gamble but wouldn't full recovery be worth the risk? I asked her if treatments were not successful and my brother died if she would be willing to pay all of the costs of treatments herself as a sort of moneyback guarantee. She did not have enough faith in her treatment to offer such.
That is a significant point I think when reviewing the real cost of health care vs the return in equity for the cost of that treatment. What are the odds of a successful outcome and what is a successful outcome? With a full recovery the person returns and continues being a productive member of society, with a partial recovery most likely they will only consume more resources and lead a less than productive and less than quality existence. With a complete failure, the substantial treatment costs have been paid in vain.
My brother opted to take the gamble without a positive outcome; while he did not leave unpaid medical bills as such, the costs to the insurance carriers was considerable. My route would have been simple pain management and gleaning the most out of the few months I had left. From a practical standpoint, my suffering would have been over much sooner, I would have had more quality of life during that time, my care would have cost a fraction of the cost of treatment, my employer would not be carrying the cost of my disability pay for nearly as long, and a suitable productive replacement would be benefiting from my job now while paying taxes and benefiting society. All with the same basic result. Even as a simple man without a lot of formal education, I can see that much of the high cost of healthcare is tied to the mixed blessing of prolonging life. Should the goal of healthcare always be longer life or should it be better life and more comfort when the end comes? Even more daunting to my limited intellect is who will decide this?