Tuesday, December 8, 2009

Avastin

Recently, I heard that Avastin is the leading cancer drug in the United States, as measured by dollar sales. On November 24, Britain's National Health Service announced that, as a result of a cost/benefit analysis, it will not make Avastin available to patients like me with metastatic colorectal cancer. Avastin is an anti-angiogenesis drug: Avastin shrinks the blood supply that tumors create to feed their rapid growth. When I go back on chemotherapy, I will probably receive Avastin in conjunction with the same cocktail of poisons, FOLFIRI, that I received when I was on chemotherapy previously. Although Avastin does not have subjective side effects, its rare physical side effects include cardiovascular events and stomach perforation.

Britain's National Health Service rejected the use of Avastin even though, in conjunction with chemotherapy, Avastin shrinks tumors in 78 percent of patients with my condition. That benefit sounds pretty impressive until one considers, according to what I read on the internet, that it translates into median survival of 21.3 months, as opposed to 19.9 months without Avastin. A modest improvement in median survival does not of course mean that some patients do not benefit significantly from Avastin.

Given our society's many needs and the budget deficit, should Medicare pay, as it will, for my Avastin? Although I have not attempted to follow all of the twists and turns of the healthcare debate, I do not think that the cost-containment proposals currently under discussion by our politicians in Washington include consideration of eliminating Medicare payments for things like Avastin (especially, one could argue, for folks who could afford to pay for it themselves). Until our nation has completed the squandering of the U.S. dollar's status as the world's reserve currency, I wonder if our politicians will have the temerity to suggest to us, the American people, that we will have to accept that there are painful limits to what our country can afford, whether it be for medical care, other entitlements, bailouts of businesses, pork-laden stimulus programs, or some notions of national defense?