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Breast Cancer & Avastin Approval

July 5, 2011

This is fascinating New York Times article that underscores a number of challenges:

While drug use should be based upon data, interest groups and patients are trying to influence public policy and drug approval in a heart-wrenching set of personal appeals.

The FDA has a mandate to respond to data. In this situation they appeared to hurry approval and study the data later. Such study did not support the approval for this application of a very expensive drug. The cost of this and other treatments is predominantly not paid for by the patient or their family but rather by taxpayers and employers and employees who fund private insurance, Medicare, Medicaid, the Veterans Administration – the major payers for health care.

Should we collectively pay for the wishes of hopes of others when quality data does not appear to support such expenditure? And how much of the price of such medications and other treatments is influenced by the disconnect between the payer and the consumer? How many treatments of questionable value would be deferred if individuals felt the impact personally, and how would prices differ paid for by the consumer/patient rather than someone else?

The moral hazard dilemma of insurance if evident in stories like this: Originally intended to help people afford unexpected expenses due to significant health matters, health insurance has evolved or devolved into payment for normal expenses like eyeglasses, routine physicals, contraception and the like. Health inflation is markedly impacted by the market disconnect between buyer and payer, and legislation has forced payment of questionable services and professionals in many jurisdictions. Whether this was envisioned when insurance became common is not clear, but it certainly is what we now have. Read more…

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