Yesterday I wrote about claims and counter-claims being made about cancer treatment. A number of statistics say that the United States leads the world in successful treatment of cancer, and those stats have become beloved of righties who argue that our crippled, hemorrhaging behemoth of a health care system is still The Best Health Care System in the World.

I suspect part of this success comes from an initiative signed into law by Richard Nixon in 1971, the National Cancer Act, also known as the “war on cancer” act. Nixon dedicated a considerable chunk of taxpayer money to cancer research and treatment. Among other initiatives, a military biological warfare facility was converted into an internationally admired cancer treatment center, and the National Cancer Institute was given unique autonomy and special budgetary authority within the National Institute of Health. Although many specific drugs and treatments are manufactured by private industry, much of the basic research that made those drugs and treatments possible was underwritten by taxpayer dollars.

Gotta love those big gubmint programs, huh?

So today, U.S. citizens with cancer enjoy superior diagnosis and treatment … as long as they have insurance. Otherwise, tough luck, buddy.

Bob Herbert writes in his column today about Lonnie Lynam, a self-employed carpenter in Pipe Creek, Texas, whose cancer went untreated because he didn’t have insurance. Lynam put off seeing a doctor for his headaches, so the tumors in his brain went undiagnosed until the pain was unbearable. Even after the cancer was discovered, he received spotty, hit-and-miss treatment because he had no insurance.

Betty Lynam flew to Texas as often as she could to be with her son. She said he needed chemotherapy and radiation treatment, but since he couldn’t afford it, he couldn’t always get it.

“He was trying to pay a little bit at a time for the doctors and for the different treatments,” she said. “But he didn’t have a savings account or any collateral, except for his tools.

“I’d ask how he was feeling, and he’d tell me, ‘Well, I didn’t get the treatment today.’ And I’d say, ‘Why?’ And he’d say, ‘Well, I got in there and they found out I didn’t have any insurance and the woman told me I’d have to come back another time because she’d have to check with the doctor or somebody.’

“He suffered a great deal. Yes, he did.”

Lynam died in March, at the age of 45.

Cancer is no longer the all-but-automatic death sentence that it once was. Extraordinary progress has been made in fighting the myriad forms of the disease.

But, as the American Cancer Society has recently been stressing, the health coverage crisis in the U.S. is a major drag on this fight.

“A woman without health insurance who gets a breast cancer diagnosis is at least 40 percent more likely to die,” said John Seffrin, the cancer society’s chief executive.

According to the cancer society: “Uninsured patients and those on Medicaid are much more likely than those with private health insurance to be diagnosed with cancer in its later stages, when it is more often fatal.”

The uninsured (and underinsured) are also much less likely to get the most effective treatment after the diagnosis is made.

There are 47 million Americans without health insurance and another 17 million with coverage that will not pay for the treatments necessary to fight cancer and other very serious diseases.

The bottom line, said Mr. Seffrin, is that “the number of people who are suffering needlessly from cancer because they don’t have access to quality health care is very large and increasing as I speak.”

In fact, the American Cancer Society is so alarmed by our failure to treat the uninsured that it recently launched an initiative to call attention to the problem. From the ACS web site:

The new initiative aims to draw attention to plight of the 47 million Americans who have no health insurance at all, and the millions more whose coverage isn’t adequate to meet their health care needs. If cancer strikes, these people may have to do without necessary treatment because it’s too expensive, or put themselves into deep financial debt to pay for care.

That’s what happened to Raina, one of the patients highlighted in the new campaign. Her insurance didn’t cover all the costs of her thyroid cancer treatment, and her family couldn’t afford the payments.

“Basically, on every medical bill that I have, they’ve turned it over to a collection agency,” says Raina, who will join Seffrin and other ACS officials at Monday’s conference.

“No one should have to choose between taking care of their health and paying their bills,” says Richard C. Wender, MD, national volunteer president of ACS and another conference speaker.

The consequences of being uninsured or underinsured can be dire. Recent American Cancer Society studies found that people with no health insurance and those with only Medicaid coverage were more likely to be diagnosed with advanced cancer than people who had private health insurance. The more advanced cancer is when it’s found, the harder it is to treat — and the more expensive, in both personal and financial costs.

It’s an article of faith among righties that the uninsured are, somehow, getting medical care, somewhere. They can always go to emergency rooms, right? Going to the ER is OK if you’ve got a broken leg, but for catastrophic or chronic illnesses it’s not working. By law, emergency rooms are required only to stabilize everyone who comes in the door. They aren’t set up to provide free chemotherapy.

Last May, righties were linking proudly to a report that said American cancer patients survive at higher rates than anywhere else because our patients get advanced drugs not available elsewhere. Captain Ed wrote,

A new study by the Karolinska Institute in Sweden shows that the American health care system outperforms the socialized systems in Europe in getting new medicines to cancer patients. The difference saves lives, and the existing Western European systems force people to die at higher rates from the same cancers, although the Telegraph buries that lede (via QandO).

As Dr. Luba helpfully pointed out yesterday, the “survivor” rate Captain Ed is so proud of is not a measure of people who are cured, but of how many people with a given cancer survive 5 years. When the Center for Disease Control gives a survival rate of 97% and a mortality rate of 26.5 for prostate cancer patients, it’s telling you that a chunk of the “survivors” will die of their cancer eventually.

The hype from May was that U.S. cancer patients lived longer because they had better access to new oncology drugs. The Telegraph reported:

The researchers, whose report is published in the journal Annals of Oncology, found that Austria, France, Switzerland and the US were leaders in using new cancer drugs.

The greatest differences in the uptake of drugs were noted for the new colorectal and lung cancer drugs.

The proportion of colorectal cancer patients with access to the drug Avastin was 10 times higher in the US than it was in Europe, with the UK having a lower uptake than the European average.

Score one for the private pharmaceutical industry, say the righties. But this article from Genetic Engineering and Biotechnology News says these results are less glorious than they might appear.

The clinical reality for metastatic colorectal cancer is that the FDA-approved combination regimen of IFL (irinotecan, bolus fluorouracil, and leucovorin) plus Avastin increases median overall survival by 4.7 months. This small increase comes with a host of side effects, which impinge upon quality of life, as well as placing a burden on the patient and the healthcare system.

While this small increase is hailed by the FDA as being impressive, the clinical reality is that there is no cure for metastatic colorectal cancer. The much-vaunted blockbuster drug Avastin is simply an antibody supplement incorporated into an already complex chemotherapeutic drug regimen that may slow down the cancer process depending on the genetic constitution of that individual. The cost of drugs for metastatic colorectal cancer alone would exceed $1.5 billion per year if all the patients in the U.S. received treatment.

The clinical reality for metastatic breast cancer is similar. The latest treatment with Herceptin followed by lapatinib and capecitabine only increased the median time to progression from 4.4 to 8.4 months. Furthermore, 70% of patients do not respond to Herceptin, and resistance develops in virtually all patients.

Of these two big killers, both remain incurable, and this sobering fact contrasts with the glowing reports on Avastin and Herceptin emanating from the financial and tabloid media.

Headlines in the popular press and blogs said that new cancer drugs like Avastin are “saving lives.” But I think most of us would agree that a median overall increase of survival by 4.7 months, while nothing to sneeze at, is not “saving lives.” This is especially true when the for-profit system that generated the 4.7 months for some patients is kicking other patients to the curb. (See also “Unhealthy Care“)

After one of my recent health care rants a rightie commenter wrote, “Life expecvtancy has little to do with health care. Cancer survival rates do. Post them.” Here you are, dude. Enjoy.

8 thoughts on “Surviving

  1. Herbert’s column brought tears to my eyes. Out (non-)system is so screwed up. And RG forgot to mention that his healthcare was paid for my the citizens of NYC, which means a lot of people who can’t medical care when they need it probably helped pay for his through their taxes.

  2. (Should have done a bit more proofreading before submitting… out = our; my = by)

    I also wanted to thank you for mentioning the National Cancer Institute’s research programs which were/are instrumental in setting up and paying for medical research. Yeah, those government programs sure are waste, aren’t they.

  3. I also wanted to thank you for mentioning the National Cancer Institute’s research programs which were/are instrumental in setting up and paying for medical research.

    Righties fervently believe all this superior medical research is being done by private industry, which is one of their reasons for maintaining a “free market” health care system. The truth is that the basic research is subsidized by taxes, and the pharmaceutical and other industries use the research and develop enormously profitable products from them. Product research is pricey, too, but IMO it can be argued that taxpayer dollars are subsidizing the “free market” at consumers’ expense.

  4. Are righties basically hard-hearted or are they just tight-fisted? I’ll ask if the occasion arises.

    Moving on, (don’t challenge me on the particulars) but the Chinese coat their plastic products, mainly toys, with a cancer-causing substance – apparently extends the ‘life’ of the product. We’re inundated with the products while the European Union refuses to import the products unless they’re not coated with the substance. China obliges. So much for our valiant fight against cancer.

  5. Among other initiatives, a military biological warfare facility was converted into an internationally admired cancer treatment center.

    And this on Dick Nixon’s watch. My word, he was downright progressive, compared to today’s Republicans.

    Righties are very pissed off at the American Cancer Society, btw, for speaking the truth about health-care and health-insurance inequities. Apparently the ACS isn’t supposed to “take sides” on health issues!

  6. Get Thee to an Emergency Room!!!

    There is no limit to the stupidiy of those on the right. That almost 50 milllion people don’t have any insurance is solace to them.
    “Almost 50 million people don’t have health insurance! That mean’s we’re not a socialist or communist society! HURRAH!!!

    S-CHIP: “Please, Sir, can I have some more?”
    “P!$$ off, kid, you’re startin’ to bother me!!!”

    We all know that money should decide whether you die or not, don’t we? That is the Republican way, isn’t it? Or, have I missed something???

    Isn’t it ironic that the prick’s who don’t want you to have condom’s solicit sex from anyone in the the next stall? And, if infected, they enjoy the best health care in the nation? On our tax dollar’s.

    Irony is DEAD!!!

  7. It’s a horrible thing when only those who are wealthy or lucky enough to have insurance can have the chance to be treated…even with healthcare, there are so many discrepancies within those plans that prevent proper treatment. For a lot of women, especially, losing your hair due to chemo treatment can be a devastating loss. Unfortunately, real-hair wigs are not covered by health plans and can cost an average of $600. I am a community ambassador with Pantene Beautiful Lengths, and together we are trying to gather 1 million inches of hair to provide wigs for women dealing with chemo related hair loss. That’s where we come in and deliver these wigs to these women and hopefully try and rebuild their confidence to give them a fighting chance in overcoming this serious illness. We could use all the hair we can get! If you are interested in donating or pledging please visit this site
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