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 couldnâ€™t afford it, he couldnâ€™t always get it.
â€œHe was trying to pay a little bit at a time for the doctors and for the different treatments,â€ she said. â€œBut he didnâ€™t have a savings account or any collateral, except for his tools.
â€œIâ€™d ask how he was feeling, and heâ€™d tell me, â€˜Well, I didnâ€™t get the treatment today.â€™ And Iâ€™d say, â€˜Why?â€™ And heâ€™d say, â€˜Well, I got in there and they found out I didnâ€™t have any insurance and the woman told me Iâ€™d have to come back another time because sheâ€™d have to check with the doctor or somebody.â€™
â€œHe suffered a great deal. Yes, he did.â€
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.
â€œA woman without health insurance who gets a breast cancer diagnosis is at least 40 percent more likely to die,â€ said John Seffrin, the cancer societyâ€™s chief executive.
According to the cancer society: â€œUninsured 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.â€
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 â€œthe number of people who are suffering needlessly from cancer because they donâ€™t have access to quality health care is very large and increasing as I speak.â€
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“)