The Editorial Board of the New York Times has just sent a warning shot across the bow of the Democrat who are trying to fast track a health care bill:

They published an editorial by Dr. Peter Singer, who is best known for his promotion of the idea that infanticide is okay, but consensual sex with Fido might be unethical–but only if it hurts the dog in the process.

Singer comes right out and advocates rationing of expensive health care, using the anti cancer drug Sutent as his example.

You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

Apparantly, the British ethical board that advises their national health service on these things (National Institute for Health and Clinical Excellence, or N.I.C.E.) is denying the drug to their patients with terminal Clear Cell carcinoma of the Kidney, and Singer sees this type of decision as good, and advises us that we can do the same to save money.

Singer’s cold mindedness here is just a more honest variation of the “utilitarian” version of medical ethics that has floated around for the last twenty years.

The bad news is that a lot of us fear that America could see a less obvious version of this type of thinking if there is a government take over of much of the health care system. Indeed, given the fact that President Obama just fired the philosophically broad “President’s Bioethics” council several months before their tenor ended does give one pause. The excuse:

The council was disbanded because it was designed by the Bush administration to be “a philosophically leaning advisory group” that favored discussion over developing a shared consensus, said Reid Cherlin, a White House press officer.

President Obama will appoint a new bioethics commission, one with a new mandate and that “offers practical policy options,” Mr. Cherlin said.

This sounds suspiciously as if they plan to pack the council with “yes” men: but until we know who he plans to appoint, and who is devising the ethics behind the health care plan, we just won’t know if they are willing to approve of withholding ordinary treatment from those whose “Quality of life” is too low to treat. (We also won’t know if they will fund abortion/euthanasia or force health care personnel to cooperate with helping to push these “options” on patients, or maybe even dispense death as part of their routine job).

However, the irony of the argument is that Singer’s example is bunk.

The reason that Sutent is so expensive is that it is a new drug, and it worked so well that it is being snapped up by physicians to prolong the life of their patients.

Before it was released, surgery was the only treatment for clear cell carcinoma of the kidney (approximately 50,000 cases a year). Yes, we did treat with alpha interferon, but it didn’t work on most patients.

Then came Sutent, and suddenly, Clear Cell Renal Carcinoma, like Colon cancer, became a cancer that you could live with for years.

So Singer’s statement about “six months” is wrong.

The “median” survival of end stage patients is over two years–and if Sutent stops working, there are several other medications that are being investigated that might offer similar long term remissions.

The second error in Singer’s editorial is the price.

Sutent, like all brand new drugs, is expensive, but the price will quickly drop as soon as it gets into wider use. (One note: alas, it does not work this well for other cancers).

His third error is stating that NICE doesn’t fund Sutent. Actually they have changed their mind.

When N.I.C.E. refused to pay for the life prolonging medicine, the company  (Pfizer) gave it away: and the strategy worked.

The drugmaker handed out Sutent to regional health commissioners in the U.K., which aren’t as strictly bound by NICE’s decisions as the NHS is. That helped build evidence that the drug worked.

So now the NICE guys will let you live.

And other European Union health systems did their fancy “Quality of life/money” analysis and decided it was worth it.

But don’t worry, Professor.

The NICE still plans to refuse to pay for dementia drugs for grannie if she’s starting to show early signs of Alzheimer’s disease.

These drugs slow the progression of the disease, so diagnosing the disease early allows physicians to slow their mental deterioration while it is still mild.

This might mean that these patients can remain at home longer, be cared for in their homes by family, and might allow them to have a fairly good quality of life until another disease takes their life.

As for the “cost effective” calculations: The dirty little secret is that a lot of our “preventive medicine” spends hundreds of thousands of dollars for each life saved. But no one is discussing this.

What is the price of years of life granted to Ronald Reagan or Pope John Paul II because their colon cancers were found early?

Our beloved ex President, Cory Aquino, is dying in a Manila hospital of colon cancer: because few people here in the Philippines get sigmoidoscopic/colonoscopic screening ($390,000 per additional life-year saved) or even Hemoccult tests on the BM ($20,000 per year life saved). (reference)

So yes, Singer’s arguments might make sense in a country where our farmers can’t afford the ten dollars a month for their blood pressure medicine.

But in the US, spending $54,000 dollars a year so that you can stay alive, work at your job, and love your spouse and children is not a large amount of money.


Nancy Reyes is a retired physician living in the rural Philippines. She sometimes writes medical essays at Hey Doc Xanga Blog.

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