POWER PERSPECTIVE

Patients' Paradox, Doctors' Dilemma

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“syringes”

The New York Times Sunday magazine asked a very provocative question in the context of a real-life choice. “Can Doctors Choose Between Saving Lives and Saving a Fortune?”

The question asked about a 60-something man who had suffered a heart attack. Doctors could prescribe drug A, a generic that costs 25 cents per pill, or a newer therapeutic, drug B that costs $6.50 per pill. Here’s the difference in clinical trials, 12 percent of patients died on the generic drug, while that number was reduced to 10 percent on the newer drug.

Would you spend the extra money for the smaller risk?

Let’s make it more interesting. Suppose you had spent through your deductible so your own personal cost would be the same. The article asks, “Would you agree to take the slightly inferior drug to benefit the (healthcare) system as a whole?

The article goes through the familiar litany of issues around cost and value. For example, “You’ve just had a heart attack, for God’s sake. You pay thousands of dollars for health insurance. Is it fair to ask you to bear the slightly increased risk to enable some broader social good?”

On the other hand, the article points out, “Our out-of-control prices have a stifling effect on the economy.” Yes, each time we go to the doctor we spend money on more tests, more procedures, more complex treatments, because often we may need them.

Furthermore, doctors aren’t trained to answer this question about the balance between cost, medical benefit and social responsibility.

While you’re scratching your head to come up with an answer…

We liked the article because it says science may be coming to the rescue. Medical science is developing biological markers and genetic tests that will help determine which patients will benefit the most from which drugs and procedures.

That’s why Patient Power has joined with Antidote and some other partners to create Precision Medicine for Me—a new grassroots, collaborative initiative starting first with lung cancer.  As we wrote previously, “One of our key premises is the need for genomic testing. Looking at a cancer at a molecular level can help determine in advance which patients are likely to respond to which treatment. It’s not just money at stake, it’s saving patients from needless treatments and wasting time when another approach could be more effective.”

As medicine develops and utilizes these tests the difficult questions raised by the Times article, won’t be a roll of the dice, but will be based on empirical facts. As the article concludes, “It’s the sort of medicine that might treat medicine’s cost crisis.”

I welcome your thoughts at comments@patientpower.info.

Andrew Schorr
Co-Founder, Patient Power LLC

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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*authors of “Cost vs. Value and the Price of Innovation in Cancer Care”

 

  •       Rafael Fonseca, M.D., Visiting Healthcare Fellow, Goldwater Institute.
  •       Noopur Raje, M.D., Professor of Medicine, Harvard Medical School. Director, Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center.
  •       Robert M. Tufts, Visiting Clinical Assistant Professor, Yeshiva University. Myeloma patient.
  •       Parameswaran Hari, M.D., Armand Quick – William Stapp Professor of Hematology at Medical College of Wisconsin. Interim Chief, Division of Hematology and Oncology.
  •       Saad Usmani, M.D., Clinical Associate Professor of Medicine, Director of Plasma Cell Disorders, University of North Carolina at Chapel Hill, Levine Cancer Institute.
  •       Paul Richardson, M.D., Professor of Medicine, Harvard Medical School. Clinical Program Leader / Director of Clinical Research, Jerome Lipper Multiple Myeloma Center at the Dana-Farber Cancer Institute.
  •       Jennifer Hinkel, M.S., Partner, McGiveny Global Advisors. Cancer survivor.
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Page last updated on April 26, 2018