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Health News, and the Cost of Cancer Treatment--Stuntz

I haven’t posted for far too long; sorry about that. I’ve been hunkered down, trying to manage chemo—which is harder this time around than it was last year—and also trying to make some progress on a book I’m writing.

So, a quick update: When I last posted, the docs had found a cluster of tumors in my abdomen, plus one tumor on my liver. I started chemo immediately. Three weeks ago, I received news of my latest set of films: the tumors haven’t shrunk, but they haven’t grown either. That’s good news—though, as always in Cancer World, news is double-edged: it means I’ll be on chemo for at least several months longer. When (I’m past the stage where it’s appropriate to say “if”) the tumors resume growing, the docs will try a modified chemo regimen. Whenever that fails, we will look either at clinical trials or palliative care.
 
Those films also turned up a blood clot in one of my lungs, which the doctors found worrisome. I’m giving myself daily injections of a blood thinner, a small piece of unpleasantness on top of cancer treatment.
 
As Americans debate reform of the health care system, I increasingly wonder at the cost of my own medical care. At this point, chemo can extend my life only modestly; there is only a slight chance I will live more than eighteen months. Less is more likely.  The tradeoff seems worth it to me, for now: I want to be around to pay more of our youngest child’s college tuition, so that Ruth need not pay those bills out of life insurance money she may need for herself. I’d also like to finish my book, and spend more time with family and friends. But while those desires are perfectly legitimate, it is also perfectly legitimate for others—my colleagues whose insurance premiums pay for my medical care or the taxpayers who would do so under a government-funded insurance plan—to conclude that my preferences do not merit the huge costs required to (possibly) extend my life a few months. How best to negotiate that gap between my preferences and the public interest, not just for me but for the many patients in circumstances like mine, is a mystery to me. But I doubt we will ever get control of health care costs if preferences like mine continue to govern in cases like mine. Which makes me wonder whether I have a moral obligation to cease chemo sometime in the near future, and let my cancer take its natural course. Not a pleasant thought, but not a foolish one either. At least, so it seems to me.
 

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Comments ( 5 )

Here are some problems with that thinking:

If you go back in history and look at the course of cancer treatments, you will find patients whose doctors said: "You only have, at best, a few months to live", and years later they are still around and kicking! My husband is beginning to look like one of those. In June of 2008 he was told he would have most likely 3 to 6 months to live. Right now, he feels better than he did that June. The majority of his "chemo" has been through a clinical trial. ALL of that chemo has been paid for by the research or drug company. Our insurance is paying for scans and doctor's appts. He (my husband) has suffered through some rough months but right now is enjoying a rather full life with the exception of being tied to our fair city every second Tues. for his chemo. We don't know how long this remission will last. We are thankful for every day. But guess what? No person on the face of this earth is guaranteed tomorrow. While we were in the hospital caring for his brother (that is another story) we heard that one of that hospital's physicians died suddenly. He was in his 50s and by all indicators, healthy. He had played in a National tennis tournament a couple of weeks prior. So perhaps HE should not have gotten health care for the last two years....b/c he was at risk for familial heart attacks???

I want to tell you that YOUR life, no matter how long you are able to extend it for, is no less valuable than anyone else's. If you use your logic we should not give anyone expensive health care b/c a heart surgery patient might die on the table or suffer a stroke within a week or two or 90 year old only has a few years left so she should die now rather than have gallbladder surgery? Oh that logic takes you down very twisted roads.

There are many, MANY cancer survivors out there right now who would NOT be alive if cancer treatments...yes EXPENSIVE cancer treatments .....had not been given to patients who had little hope of extending their lives at that time for much more than a few months. But the docs learned from those patients' experiences. That is what has made our health system so fabulous...the best in the world! Yes....it has major flaws and costs are getting out of hand but it is STILL the best.

In my opinion, the time for you to stop treatment is when you can no longer tolerate it or when it is clear that it is no longer working and there are no other options.

It is easy to feel guilty at times for having something that is not available to everyone but if you want to go down that road, you would need to give up your car, your house, your job...everything. If that is what you are saying, it might have more credibility.

Your transparency with your readers is a true gift to us. Thank you.

You're a courageous and honorable man, Bill.

Advice from a Complete Stranger

I don't know you, and you don't know me. Based on your logic, I should want you to cease spending MY money, right?

I will say that I am a capitalist (former, and perhaps future, investment banker).

That said, I think you should do whatever you can to stay alive. I don't mind spending the money.

Human life is precious and unique. The loss of a life (in most cases) is a loss for all of us survivors.

Enjoy your life and contribute what you can (in a professional capacity). A book is certainly a great way to contribute.

Spend time with your family and enjoy them.

Also, I agree with Jo McCabe. Just because "they" say 18 months, it doesn't mean that they are right. There are statistics that they MAY be using as a basis. Any population (I had to take statistics for my BS and MBA) has outliers. If the markets have proven anything over the past two years, it's that thin tails and normal curves don't describe human behavior (or much of anything else about humans except height and weight).

In addition, treatments are being researched 24 hours a day 7 days a week.

I devote a significant amount of my time to a charity that funds cancer research (and scientists the charity funded made discoveries leading to Gleevec, Doxil, and Velcade - amongst others). Despite the Great Recession, we were able to grant more funds for research this year than ever before.

There is hope of making cancer a chronic condition rather than a death sentence. Hopefully cures will be developed soon too.

Please don't give up.

I appreciate the sentiments you expressed. I just think you should be selfish for yourself and your family.

Be well,

Larry Loeb

Bill, stewardship is a hard topic. Since you are able to discuss it so dispassionately, I'll rather analytically explain why I think your particular case is made easier by three things, from an economist-Christian's point of view:

1. If it costs X dollars to keep a person alive, and the person earns Y dollars in the meantime, with Y>X, the effort is socially worthwhile even without having to think about nonmonetary value. Even a cold-blooded slaveowner would give medical treatment to his slave in that case.

2. If besides his earnings, the person will also write a good book, that's an additional benefit for the world.(I know there are benefits to family and friends, too, but I'm trying to point to what's special in your case.) What you write is very good, whether it's on crime, cancer, or Christianity. Your recent Christianity Today article is an example: http://www.christianitytoday.com/ct/article_print.html?id=84612.

3. If the cost is due to the price of patented drugs, the social cost is less than the dollar price. The marginal cost of producing the drugs is probably very small. The price is high because society needed to give incentive to companies to develop that drug, but the development cost is sunk, and if you stop taking the drug, the world can't get that development cost back.

When society-- the individual or the society as a whole-- should spend on health care is a hard problem.