Were developing Drugs that are ridiculously priced. Medical Research is going “Out of Control” all for we don’t want to die. Insurance Companies are going to make Us all pay. What about Us Who don’t have Insurance?
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Holy smokes! All the donations that have gone towards cancer research should not be counted in the cost. That’s not money that should be recovered.
Not sure I’m understanding entirely what you’re getting at there. But all the research does very much count as cost whether we approve of or like it or not. Since people need to be compensated for their labors, that compensation must come from somewhere! It may be tax dollars that help (in some countries). But for big pharma firms, …it’s a contributing factor to the cost of drugs.
There is a dilemma to be acknowledged here that warrants good discussion, especially in a Christian context. It’s easy to criticize all the millions of dollars we throw at the end of a human life - I am critical of that too. But one should at least be able to acknowledge how this feels if it’s your own Aunt Letty on life support, and there’s good hope (at least in your own mind) that she could have a full recovery and live many more years with you. In that personal context, we rebel against the implication that Aunt Letty’s life is only worth so much $$$, beyond which, let’s pull the plug! It’s one thing for me to declare (for myself, and perhaps literally in a medical will) that I do not want these or those extreme and expensive measures taken to sustain my own life; but it’s quite another to make that same declaration as a matter of policy on behalf of other people. Insurance expense muddies these waters since we now all share in that cost whether fairly or not.
These are difficult issues to resolve, and will almost certainly never be resolved to everyone’s satisfaction or moral approval, even if or when “the best possible” solutions are found.
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In medicine in the USA, prices often mean very little. Discounts are plentiful, and programs exist to fund those who cannot pay, though there are certainly those who fall between the cracks with little ability to get the drugs. One of the drugs I am taking costs 15,000 monthly list price, but my out of pocket price was 2000 for the year as I met my deductible on Medicare part D the first month. Thank goodness I only have one month of it to go. One of my pharmacy company friends was telling me that the average cost to bring a new drug to market is about 2 Billion dollars. You have to treat a lot of pancreatic cancer to get that back before the patent runs out. It is a tough problem though, to finance research and still make new drugs affordable. I don’t think the current administration is correct is essentially saying to heck with research and new drugs.
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The problem could be split to smaller modules that might make the issue more understandable.
What we have here is
- a need/demand at the patient level;
- the need to make profitable business at the enterprise level
(otherwise the company goes bankrupt); - societal/political prioritization of what is important for the community/government/nation.
An additional point is where do the funding for the research come?
In medical sciences, much of the research is funded by the medical companies and they need to get a compensation for the investment they have put into the resarch. The patents are designed to answer to this need.
The other side of the coin is that much of the innovative scientific work is done in universities and research institutes that receive public funding for research. Universities invent and develop novel innovations, then the companies take the novel findings, develop applications and then try to capitalise by claiming that they developed this innovative product and need to be paid for their work.
Individuals do not often have the money needed for expensive medical treatment and governments may not have the political will to pay such costs. That opens a niche for insurance companies. Insurances have their prices because the companies have costs.
If the commercial sector of the society is given free hands, the companies try to maximize their profits. Companies are not just collecting compensations for their costs, they aim to making their owners and shareholders rich by collecting as much money as they can squeeze from the customers. Without a sufficiently influential counterweight, the customers/patients are the ones that pay and suffer.
Governments could act as influential counterweighs but there is not necessarily sufficient political will to do that. USA is an example of a nation where such actions are not prioritized by the voters and governments. Pay your own bills or die, that is the basic spirit. The liberal freedom of markets leads to an expensive medical care system - more expensive than in countries where much of the costs are paid from tax money.
By the way, that is one reason why I am not an USA citizen. My grandpa was born in USA but there were health problems in the family and they did not have enough of money to pay for the expensive medical treatment in USA. Because of this, the family moved to Finland, where they could get medical treatment with a lower cost.
Balancing all the factors together is not an easy task. There is always someone who pays and someone who collects the money. Whether there is a need to limit the creed of the company owners or help the patients that suffer at the level of the whole society is a political decision that the voters need to answer. So far, the decisions have not favored the patients. If this is what the voters want, that is how they have to live.
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There is always a limit to how much we or the society can or are willing to pay for the medical care.
If the bills come to my desk, I can only pay what I have. If I cannot pay and someone else does not aid, then the reality is that we have to pull the plug.
At the societal level, the problem has become worse with the invention of new drugs that are somewhat more efficient than the previous ones but much more expensive. Medications may cost >0.5 million $ per year for each patient. If the medical care is paid from taxes or comparable sources, there is a need to set the limit somewhere.
Here in Finland, that is an ongoing public debate. There are stronger demands for cost-effective treatments, meaning that the expensive drugs are only used if there is scientific evidence that the treatment is necessary and gives much better results than the cheaper drugs.
In some special cases, the government has even made deals where the payment depends on the results: if the novel drug helps as promised, the costs are paid from public funding; if not, then there is no payment for the medical company. The deal may be acceptable for a medical company if the alternative is that the drugs are not bought and the profits from a single patient are considerable. We are talking about drugs where the annual cost may be a million $ per patient.
We might compare this to what people are prepared to pay for the treatment of their pet dog. Larger operations cost typically >10’000 € and medication may also cost >1000 € per month. Many are willing to pay such prizes when there is a possibility to get several good years with their dear pet. However, when the dog is old or the expensive treatment gives only a temporary relief, at some point there is a need to stop and admit that it is the time to pull the plug.
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There has been a lot of inflation, but I remember a discussion at a medical meeting years ago that in the research community, the “standard” for recommending a medication or treatment was about 50K per added year of life. Probably it is up to 200K or so now. Anyway, when it is said there is no price on human life, no matter where you live, that is really not true in a statistical sense. If you treat something like heart disease with a medication, you would expect at 200k per added year, if the cost was a million per patient, you would expect an statistical increase in longevity to be 5 years. That is what makes childhood immunizations so cost effective. If you save a child from dying from pertussis, you increase longevity by 70 years or so, which is huge. Giving a cancer patient an extra year, not so much. But, the potential cancer patients tend to be ones running the world.
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Very much so
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The most expensive drugs are gene therapies. AI listed as the most expensive the following ones:
- Lenmeldy: Around $4.25 million for a one-time treatment targeting metachromatic leukodystrophy (MLD).
- Hemgenix: Around $3.5 million for hemophilia B gene therapy.
- Zolgensma: Around $2.1 million for spinal muscular atrophy
It is great that there exists such gene therapies but I understand why there are debates about the costs. Multi-millionaires can pay such amounts but for the others, that may be too much. In health care systems where the local taxpayers or a small insurance company pays the costs, a few such cases can cause a budget crisis. There is an upper limit to how high taxes can be accepted or how high the insurance payments can be.
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Your post brings up a number of issues that are worth discussion individually as well as in concert:
How the public understands specific diseases
How that understanding affects a community’s or society’s prioritization of handling diseases
All sorts of moral issues related to treatment of disease.
How societies understand access to health care (- right or privilege? Equity or earned?, etc.)
How societies understand responsibility of individuals to the community, and communities to individuals
The complexities of how societies “value life”
The complexities of how societies view end of life, extreme aging and death.
Super expensive treatements like the one you show as an example shove in our faces inequeties we regularly ignore in the US. There are all sorts of people who can’t afford even basic healthcare, because our system is set up in a way that helps the people who least need help with healthcare costs. That quality of insurance coverage is comensurate with the “quality” of the job one has. If one has insurance at all. Insurance companies will likely not be willing to pay for something like the drug in your example, or if they do, it’ll be for the most high-end policies for the best compensated workers.
My mom is 93. She’s beginning the obvious (to us) process of failing, which her doctors probably saw years ago. In her case there are not any real options for dealing with what’s wrong. Original equipment fails. We know this. So, the choices are “simpler” than in your example.
But death is still the great unknown. Even for Christians. We can say what we like, but there is nothing like experiencing it yourself. And watching a person die - which I have done more than once - doesn’t tell us a thing about their experience of death. We have no record of Jesus telling his disciples what the experience was like. Or the experience of being resurrected.
We need to handle questions about treatments carefully, understanding that we will experience ourselves what someone else is facing more closely - death. It’s easy to minimize others’ view of death when we feel like we have all the time in the world. But I can watch my mom and calculate based on averages about how much longer before my own life will end, if I stay healthy. That’s sobering.
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And is quality of life a factor? Should it be?
My own mom spent her last years (died at 83) with progressively severe dementia (far past the point of familial memory being gone … even language was completely gone at the end). It wasn’t lost on our family that a decade or so earlier - while she was still of relatively lucid mind - she had suffered a heart attack that an attentive doctor caught on a routine visit and rushed her off to surgery. Stents were put in and her life was duly prolonged by many years, eventually causing her physical body to outlive her mind by quite a few years. I have the vague impression (though I don’t recall her explicitly saying this), but while she could still talk, expressing disappointment that she hadn’t gone earlier. That could also be my perception too given her personality and types of preferences back when she could express those things well. It sure had an impact on the rest of our family and our own end-of-life kinds of desires. My sister elected not to fight her second round against colon cancer and just make sure that she died before anything could possibly progress that far. In her case, she’d had enough of the whole colostomy bag experience and decided death was clearly better. But I suspect her watching how my mom’s life ended also impacted her in important ways.
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I am in a comparable situation, with my mom being 94, father a bit younger and both having serious health problems. I can see the stepwise failing with age, which has accelerated during the last year.
Luckily, both are believers and do not fear death. We have talked about it, the last wills have been updated and my mom has started to give away her possessions to her children, grandchildren and grandgrandchildren. Both parents have recorded as their living will that when the heart stops, no resuscitation is allowed. That excludes also major operations where the heart may stop. When the heart stops, it is the time to go.
My godfather, also a believer, told before his death that he does not fear death but he fears dying. That door is an unknown and there is maybe also the fear of painful death.
Death is natural. If we believe everything will be better after the death, there is no need to fear.
There may be worries about what will happen to those who are left behind, about possibly painful dying, about matters that we did not do or say before the death. If we can face our mortality before it is too late, maybe we have time to try to correct what can be corrected before we leave.
Every morning is one day closer to the day when we leave.
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I experienced a Medical Realm bothersome situation with one of Sisters. She had some form of Blood/Bone Marrow problem and the Doctors banned Me from seeing Her before She Passed. They only let Her Husband and One Daughter see Her, for they were afraid of Her catching some other Germ. This is to Me the Doctors are Playing God, and They are in Control not God. I did finally see Her in the Open Casket, She wasn’t Cremated.
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Absolutely. This is important and I neglected it. Although it was in the back of my mind.
I appreciate the examples you gave, and I have similar ones in my life. And I think the people we have in mind here made sound, ethical decisions.
These important decisions are complicated though by the need to reorient our thinking to dealing with known end of life from preservation of life, which is what we spend so much of our lives doing. There can be a lot to struggle over in this process.
Knowingly wasting limited medical resources in order to “just do something” for someone who cannot benefit much or at all from the treatment strikes me as unethical grasping. We need statistics sometimes to help us see the way. And that can seem heartless
The biggest problem with quality of life issues like your mother’s heart and mind is that we don’t know the end from the beginning. Only when it gets here. And often we have no idea what to expect in between.
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I don’t think it’s moral to purposefully terminate our own lives but I think there is a difference between letting nature take its course in some cases.
My wife endured 2 rounds of surgery for vulva cancer and one 30 days round of radiation which was so bad she had to spend a month going into a hyperbaric chamber for healing. She told me flat out she’ll just die before doing that again. In this case it wouldn’t be an option anyways. We are going for biopsies next Wednesday. We feel we are going into surgery round three as it seems to us it is back within a year of the last surgery. Sometimes she’s gung ho in a fighting mode and sometimes she’s just really tired of the pain. I’m just here feeling as useless as a sack of potatoes trying to show love. I can understand not wanting to fight anymore and I hope it never comes to that, but my wife only gets my support in whatever she chooses if she has to make such a decision. She’s in lots of pain at the moment and also sharing time with her sister to take care of her 82 year old father who has dementia. He still has significant use of his mental faculties so we are blessed there. But it is a challenge and is probably only going to get harder from here.
Vinnie
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I see all of Life and this Molded Planet as “Our Father’s Creation” and it’s not NATURE. Nature is a Man’s covered up word for Scientific Evolution. I Believe this is all The Almighty’s Creation and The Almighty is Responsible for This Creation and Life. We in turn cause confusion of how We identify Nature or Creation. This correct to call Us Creatures(Created) but not Nature’s Evolution. I know I’m being ridiculously picky, but this is what we learned and this is Why Jesus Said “Father forgive them for they know not what They do” We are all influenced and taught by Each Other like the Roman Soldiers.
@graft2vine
DONATIONS!!!
Since when are donations something to be recovered? Does that mean when I make a donation I can expect it to be returned to me? And if the person making the donation cannot expect a return then why should anybody else expect a return for my donation?
I think the proper criticism of this remark is whether the donations for cancer research are really that significant a part of the cost for making these drugs. So… come on… let’s see some actual numbers rather than empty rhetoric.
As for the rest of it… fear death? not so much. But other people can spend THEIR money as they choose, and I cannot support some insane notion that we are all entitled to what they spend their money on whether we have the money or not. Should we somehow forbid people from having anything to spend money on things according to some weird idea of equality? …get real!!! That is what money is for. Cannot say I understand how others spend their money and why they value those things… but that is their business not mine.
It looks to me Gene Therapy is Playing God, but not Everyone believes in God.
Well said!
Historically this meant that the wealthy functioned as guinea pigs for the rest of us: they tried and thus tested new medications and procedures.
Interesting and valid observation!
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Huh? “Nature” is a term found in hymns written before evolution was ever proposed.
People said the same thing about surgery.