Bring on the death panels. Please!

Somebody needs to decide when a drug costs too much

An Associated Press story published this week encapsulated much of what’s wrong with America’s health-care system. The story reports that Medicare officials have agreed to cover the cost of a new prostate cancer drug called Provenge. The Centers for Medicare and Medicaid have ruled that the drug, developed by Dendreon Corp., is a “reasonable and necessary” treatment that will now be available to millions of men in the incurable stage of prostate cancer. Good news, right?

Um. Not exactly. The drug costs $93,000 per patient. And it typically extends the lives of those who take it by four months.

Four months.

By law, Medicare can’t take a drug’s cost into account when it decides whether to cover treatment, and most drugs cleared by the FDA are automatically covered. Provenge costs so much because it’s customized to suit each user; Dendreon spent more than a billion dollars to develop the therapy. And prostate cancer sufferers note that those four months of extra time are double the average survival time for patients undergoing chemotherapy—minus the side effects.

But bioethicists are made queasy by the decision, pointing out that the American health-care system rewards these sorts of highfalutin high-end treatments even as it neglects basic, primary care that could have far more lasting effects on the health of the population as a whole. The smallest neighborhood hospitals are in a fever to acquire gamma knives and robotic surgery rooms because everybody else has them—even as vast segments of our population have no insurance and no access to preventive care. This is no way to run a country, people. How many childhood vaccinations would one patient’s $93,000 pay for? How many Pap smears, or diabetes screenings, or blood-pressure tests? How many lives is one man’s four months more worth?

I hear you saying it: “But if it were your husband, or father, or son … ” Sure, I’d be concerned. I’d want the extra time. But we can’t all have what we want just because we want it. Not when it costs that much. We need to stop medicine’s nuclear-arms race and figure out a fair and humane way to make these sorts of decisions using a matrix based on the common good, not just our own. But maybe we’re already too far along the road to “me, me, me” to ever get back to “we” again.