Rational Rationing

Full disclosure: I stole that headline from an article on Pharmalot that triggered this blog. It reported on a New York Times op-ed piece by doctors at Memorial Sloan-Kettering Cancer Center in New York City about why the hospital won’t use the newly approved drug for metastatic colorectal cancer, Zaltrap.

Their reason? The drug is not any better than the currently used treatment, Avastin, and it costs more than twice as much, about $11,000 for a month of treatment.

Rational? Yes. Rationing? No.

It’s not rationing because patients can always go to another hospital and get the drug, which I know they’ll do because in this country we believe “new” is always better in medicine.

I saw this in action when I was a newspaper reporter (remember newspapers? You held them in your hands and got ink on your fingers?). Back in the day, I covered the “bone marrow transplant” story. This was when women with breast cancer demanded  bone marrow transplants even though there was no evidence that this highly toxic, highly dangerous, extremely expensive approach worked. Since the procedure was considered investigative, their insurance companies refused to pay for it. The women sued insurance companies, went to the … Continue Reading

cancer drug healthcare costs Memorial Sloan Kettering rationing Zaltrap

Why You Should Ration Your Healthcare

Questions and Answers signpost A few months ago my 72-year-old mother told me she was having a CT scan because she had a lot of back pain. Her doctor thought it was a bulging disc. Given her age, it was most likely related to degenerative disc disease, i.e., old age. He had already prescribed physical therapy and some anti-inflammatories.

So why, I asked her, are you having a CT scan? How would your doctor’s treatment plan change based on what the CT shows? Are you going to have surgery? Take stronger drugs?

She couldn’t answer. She couldn’t answer because she never asked the questions. Just as she never asks her doctors why they prescribe one medication over another, or why they recommend knee arthroscopy for her aching joint (which studies find no more effective than conservative medical treatment) instead of knee replacement (which studies find extremely effective both from a medical and a cost perspective because it keeps keep older people active, reducing the risk of additional medical problems and improving their quality of life).

Now, this is not to pick on my mother … Continue Reading

cost managed care rationing