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August 06, 2010


Just a few days ago Brendan acknowledged that rationing is a legitimate concern and said that it is not the same as "death panels." Now Brendan seems to have backslid. Vitter expresses a concern about rationing, and Brendan treats it as having raised the issue of death panels, even though the AP report Brendan admires points out that Vitter never used the term "death panel." Brendan is becoming the Joe McCarthy of the health care debate, finding death panel alarmists under every bed.

It's too bad that we don't have a link to Vitter's actual comments. A portion were presented at RedState:

Senator Vitter wrote in a letter to Dr. Richard Pazdur, head of the FDA’s Office of Oncology Drug Product, that “based on a review of the FDA Advisory Committee’s report on Avastin no new safety concerns were raised with the drug. Rather the Committee’s concerns appear to have been based on cost effectiveness.” The FDA has a criteria to only approve “clinically meaningful” drugs. Senator Vitter’s concern is that cost is a factor in this ambiguous and vague standard. Adopting a de facto government run healthcare system will empower federal bureaucrats to make these types of arbitrary decisions on a mass basis for all Americans. Rationing is a fatal flaw with the intellectual underpinning of ObamaCare

OTOH the AP article says:

But the FDA and its advisory panels don't consider cost effectiveness when reviewing drugs for approval; the agency is charged only with reviewing a product's health risks and benefits.

It's a factual question of whether the FDA considered cost in evaluating Avastin. Even if they didn't, in the future, some arm of the government will have to consider cost. There just isn't enough money to pay for every possible treatment to every possible patient.

It's conceivable that Health Reform might work well, despite rationing. However, it's a shame that reasonable discussion of how the rationing might be dealt with are considered taboo. What Brendan sees as debunking myths, I see as working to maintain a taboo.

Rob: This statement ("It is sickening to think that care would be withheld from a patient simply because their life is not deemed valuable enough.") is almost a direct paraphrase of Palin's "death panels" post on Facebook. (Also, I don't see any evidence this has anything to do with rationing.)

David: Where's the evidence they considered cost? It's an assertion by Vitter with no available evidence. The drug doesn't improve survival and has worse side effects. There's a reason the vote was 12-1.

Brendan, true enough that Vitter's statement nearly paraphrases Palin's Facebook comment. Equally true that Palin's Facebook comment essentially paraphrased the published statement of Administration health care advisor Dr. Ezekiel Emanuel about judgment of level of productivity in society, and that Palin's comment explicitly addresses the issue of rationing care. If we're going to go back to Palin's comment, the "death panel" bugaboo needs to be viewed in the wider context of Emanuel's statement and rationing, rather than treat anything even reminiscent of "death panel" as outside the bounds of proper political speech.

It's interesting that when considering the Arizona immigration law, the left is alert to the possibility that those administering the law will consider factors in contravention of the specific anti-profiling language of the law, whereas when it comes to what considerations are made by the FDA, the left (here represented by the AP and Brendan) concludes that since cost of a treatment is not specifically listed among the factors that should be considered, then it wasn't and couldn't be a factor. BTW, it's useful to remember that the issue here is whether a drug should be made unavailable for prescription by oncologists, even if they conclude that in certain circumstances it may extend life or improve the quality of life without extending it.

Brendan -- my wife, who has had dealings with the FDA, agrees with you that they would not have considered cost in their evaluation of Avastin.

However, rationing will be an inevitable part of government-paid health care. The government will have to limit its coverage to what it can afford. By the same token, insurance companies limit what they will pay for.

I don't know whether government rationing will be less onerous than insurance company rationing. I do think it's appropriate that we address the details. Demonizing anyone who raises the question prevents useful communications.

I stand corrected. Dan Riehl points out that the issue with Avastin is not whether it will be available for prescription but simply whether its cost will be reimbursed by Medicare and most private insurance companies. Riehl includes a statement by the director of Cancer Clinical Trials at the Montefiore-Einstein Cancer Center that Avastin does improve one-year survival rates for about 5% of patients.

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