machado: it's time to dismantle a system that makes survival too expensive

decisions on how to treat based on dollars

if i were a quant guy, i might say that was bananas. if i were that guy comparing the cost of keeping one person with cml alive, versus, say, the three million canadians taking cholesterol-reducing statins at an individual annual cost of roughly $1500, it’s not hard to understand why, using only this criteria, one might (as regulators are wont to do) consider readjusting the drug-spending ledger. except that patients deserve so much more than being slid into a spreadsheet of haves and have-nots, just based on what hurts the pocketbook most. instead, more than ever, we need decision-makers, and experts like the md anderson docs, to dig deeper and stop wasting time and energy finding ways to squeeze us into impossible financial models that are largely driven by corporate profits and complex pricing systems. instead, let’s do the right thing. make those financial models fit the needs — and lives — of patients, and finally, take aim at the real crux of this entire debate: why the heck are these treatments so expensive in the first place?

in the meantime though, we are left with not-good-enough perspectives like the ones from the md anderson docs. they acknowledge expensive drug costs, and concede that it’s good clinical practice for doctors to help u.s. patients access the most affordable generic cml treatments. yay. but in the next breath, a little willy-nilly, if you ask me, they throw in the stem cell transplant (remember the serious risks, plus chance of death) card effortlessly as an alternate, viable and cheaper treatment option. they go as far as to call it an “affordable, curative later-line therapy” when “cost considerations are important to the patient and the regional health-care system.”

a stem cell transplant is onerous and difficult

how much does the risk of death cost?

perhaps the md anderson docs should consider a do-over. instead of putting forth a cost-savings perspective that potentially puts patients at risk, start a discussion about financial toxicity and the economic impact of cancer care. set out with a plan to dismantle a system that sometimes makes survival too expensive and where cost can determine quality of treatment, and instead, turn it into a framework that gets medication to everyone who needs it.