Father's Day 2006: The issues

The above cartoon shows why "the average" can be a misleading statistic. Click to see a larger, more readable version.

Again, click to see a larger version. No comment needed...

Now for some political issues that are on my mind: The Daily Kos has a couple of recent diaries on health care that are worth reading:

First, a report about a drug that can treat blindness that has been blocked because it isn't expensive enough:

http://www.dailykos.com/story/2006/6/17/214451/082

Blindness caused by macular degeneration. Lots of people get this eye disease and their sight becomes drastically impaired. You'll remember that just this week our president made an issue of a reporter's keeping on his sunglasses while asking a question of the president. The man who is legally blind has this disease as do 20,000 in the UK alone each year.

According to the Guardian, of the UK, Genentech greedily intends to stop the use of Avastin for the purpose of stopping blindness. Instead, they will not test it for that purpose.

They want to push their own partial Avastin formulation that will cost people 100 times more!!

Lucentis, the replacement drug, will cost about $1,850 per shot.

The source: http://www.guardian.co.uk/medicine/story/0,,1799772,00.html

which reports, in part:

A major drug company is blocking access to a medicine that is cheaply and effectively saving thousands of people from going blind because it wants to launch a more expensive product on the market.

Ophthalmologists around the world, on their own initiative, are injecting tiny quantities of a colon cancer drug called Avastin into the eyes of patients with wet macular degeneration, a common condition of older age that can lead to severely impaired eyesight and blindness. They report remarkable success at very low cost because one phial can be split and used for dozens of patients.

But Genentech, the company that invented Avastin, does not want it used in this way. Instead it is applying to license a fragment of Avastin, called Lucentis, which is packaged in the tiny quantities suitable for eyes at a higher cost. Speculation in the US suggests it could cost £1,000 per dose instead of less than £10. The company says Lucentis is specifically designed for eyes, with modifications over Avastin, and has been through 10 years of testing to prove it is safe.

Unless Avastin is approved in the UK by the National Institute for Clinical Excellence (Nice) it will not be universally available within the NHS. But because Genentech declines to apply for a licence for this use of Avastin, Nice cannot consider it. In spite of the growing drugs bill of the NHS, it will appraise, and probably approve, Lucentis next year.

Although Nice's role is to look at cost-effectiveness, it says it cannot appraise a drug and pass it for use in the NHS unless the drug is referred to it by the Department of Health. The department says its hands are tied.

"The drug company hasn't applied for it to be licensed for this use. It wouldn't be referred to Nice until they have made the first move," said a Department of Health spokeswoman. "They need to step up and get a licence. If they are not getting it licensed, why aren't they?"

New drugs for the condition are badly needed: those we have now only slow the progression to blindness. With Avastin, many patients get their sight back with just one or two injections.

Avastin was first used on human eyes by Philip Rosenfeld, an ophthalmologist in the US, who was aware of animal studies carried out by Genentech that showed potential in eye conditions. This unlicensed use of Avastin has spread across continents entirely by word of mouth from one doctor to another. It has now been injected into 7,000 eyes, with considerable success.

Professor Rosenfeld has published his results and a website has been launched in the US to collate the experiences of doctors from around the world. But although the evidence is good, regulators require randomised controlled trials before they grant licences, which generally only the drug companies can afford to carry out.

Prof Rosenfeld said the real issue was drug company profits.[...]

Of course, I should point out that there are problems with Avastin:
http://www.medindia.net/news/view_news_main.asp?x=8235&t=1

Researchers at the Genentech Inc.'s said that Avastin, a cancer drug may cause trigger a rare brain condition, reversible posterior leukoencephalopathy syndrome. This was published in the New England Journal of Medicine.

It was found that two female cancer patients in their 50s treated with Avastin developed reversible posterior leukoencephalopathy syndrome (RPLS). This condition leads to blindness and other complications. Doctors said that both the patients have recovered.

Hal Barron, Genentech's chief medical officer said that his company is investigating a possible third case and is undertaking a review to see whether other patients have signs of the condition. The company also said that it will revise prescription information on the drug, which had $1.13 billion in sales last year.

I wonder if this is part of the issue. Still, this doesn't look good.

Next, we have another diary about health care; this one is about insurance companies:

http://www.dailykos.com/story/2006/6/18/12264/2083

But I'll tell you what my doctor scorns more than anything--insurance companies.

My doctor loathes the for-profit insurance companies. He loathes the assault on his patients and all Americans by the Bush regime.

Make no mistake, 48 million Americans without insurance is by design, not by accident.

I would think that most American doctors have by now received the message: mess with insurance companies, they can destroy you. This is their plan--intimidate doctors into submission. Intimidate doctors into silence. Make doctors tow the line.

Send out the word, if you fight for your patients, we can make your life very miserable.

Some doctors have decided to fight back.

These are some things he may write about, I'm just guessing, but stay tuned:

1. Patients denied life-saving medication by insurance companies.

2. Undocumented patients who show up in the Emergency Room who may soon be required to show proof of their legal status.

3. Patients who require diagnostic tests being denied medically necessary treatment from bottom-line obsessed insurance companies

4. The swamped emergency rooms--the last hope for the 48 million uninsured.

5. Ever-changing insurance company drug formularies. He prescribes a drug which one week is approved, the next week vanishes.

6. The hours and hours he spends on the telephone with insurance company clerks pleading on behalf of patients.

7. The pitiful reimbursement he and his colleagues accept, while the CEO of Wellpoint pockets a billion dollars worth of stock options.

8. The Bush assault on cancer research, stem cell research, the HPV vaccine, Plan B--the Bush assault on science.

9. Being second-guessed and questioned by insurance companies about treatment every step of the way.

And I'm sure he'll discuss the latest insurance company gimmick to reign in skyrocketing costs, performance incentives:

Blue Cross Blue Shield of Massachusetts is pressuring doctors and hospitals to provide better, lower-cost healthcare by doubling to $189 million the amount it will spend on performance incentives this year.

The move puts the state's largest health insurer at the forefront of a nationwide effort by insurance companies, which want to move away from a long-used reimbursement model: automatic payments to doctors for the care delivered.

Blue Cross and other insurers say shifting to contracts that make some portion of payments contingent on quality and efficiency will help make healthcare more cost-effective.

The nonprofit company said the steps, which are generating criticism from some doctors and hospitals, are needed to address skyrocketing health premiums, which have risen more than 10 percent annually for five consecutive years.

http://www.boston.com/...

We really need to focus on issues like these instead of things like flag burning. I am not saying that my idea (single payer system) would be the best one; I am not an expert in this field. But we need a solution.