Drug Use and Choices by Society
By Rick Redalen, M.D
Today all of us get continual bombardment by the media on various subjects. They always try to appeal to our emotions rather than our sensibilities. One of the most emotional problems we deal with in medicine within our families is cancer. Whenever we hear that a new cancer drug is not approved, we are apt to get up in arms because we feel our government is withholding treatment from a poor patient that may have exhausted all currently available manners of treatment and the last hope seems to be a new experimental drug.
None of us like to think that decisions about our health care are based upon economics, but the truth of the matter is they are. Always when looking at a treatment the cost must be taken into account. I am going to use thinking by the UK for this example so you know all government agencies go through these same thought processes. It does not only happen in the United States. In May 2010 the National Institute for Health and Clinical Excellence (NICE) decided not to support the drug sorafenib (Nexavar) for treatment of primary cancer of the liver. The price of the medication was $42,500 per course of treatment.
Physicians and citizens reacted somewhat angrily. They said NICE may save money but it doesn’t save lives. They did not mention that Nexavar did not save lives either. It simply prolonged lives 2.8 months. We must always remember that these medications are pushed because Big Pharmaceutical Companies may have spent millions of dollars developing these new cancer drugs and they want a return on their investment.
Gaps in our Medical Care
Dr. Rick Redalen, M.D.
From "The Health Wagon" which aired on April 6, 2014, and was rebroadcast on March 27, 2016. Scott Pelley is the correspondent. Henry Schuster and Rachael Kun Morehouse, producers.
A recent segment on 60 Minutes entitled “Affordable Care for those still uninsured” brought to light the enormity of the gaps that exist in healthcare under ObamaCare. The segment featured a 2014 script from “The Health Wagon,” described as medical mercy for those left out of Obamacare. It was rebroadcast on March 27, 2016, a strong indication the situation we face is growing worse.
Although nearly 13 million people have signed up for ObamaCare, millions have been left out. Obamacare told the states to expand Medicaid, the government insurance for the very poor. But 19 states declined. The citizens of those states fall into a gap that exists for those who make too much money to qualify for Medicare but not enough to buy insurance.
Many patients seeking health care today are forced to seek a lower cost of care. They often see Physicians Assistants. Many of these patients are experiencing severe illness because they cannot afford to see a doctor, pay for laboratory testing or buy the medicines they need.
One such example is Glenda Moore whose job at McDonald's making biscuits did not include insurance she could afford. Glenda needed $114 up front just to be seen. That amounted to half of her weekly pay (she earns $7.80 an hour). The $500 for a prescription of Lovenox was out of the question. She was eventually diagnosed with stage IV lung cancer which had metastasized to the brain. Glenda died three months later. Perhaps her story would have remained the same. The problem is, Glenda did not get to find out. She could not afford the much more timely visit to a physician who could have made an earlier diagnosis that may have prevented her death.
These 'gap patients' would be taken care of in the 31 states that expanded Medicaid under Obamacare, but in opt-out states, many patients like Glenda Moore have fallen through this unintended gap.