First, do no harm. Have we forgotten?

Wish has not yet been granted
Wishing Well

While cleaning out my garage yesterday, Dennis, who lives across the street, stopped by to drop off an extra jasmine plant he didn’t need. Since I moved in here over 20 years ago, his family and their revolving door of feisty little dogs, their renewing fleet of shiny new trucks and cars, including now a Model T, and their invitations to birthday parties and graduations have brought a strange calm to my existence. In my private mind, I think of Dennis as Wally Cleaver grown up. Everything about him says stability, except for his health.

Over the last fifteen years, Dennis has been a warrior, first battling two bouts of melanoma, then overcoming a dreaded intrusion of prostate cancer, and for at least seven years he’s been kicking back a persistent form of leukemia, likely triggered by RoundUp. I had just heard he was no longer in remission, so I asked him how he was doing.

“I’m feeling much better since starting the new drug—it’s the latest technology in fighting blood cancer,” he said proudly, gratefully. Then he leaned in and quietly added, “You know, it costs $16,000 a month.”

Mortified, I felt like my inner volcano just might erupt. Noting this, he said, “At least I have insurance, and they cover the whole thing—the whole enchilada.” Well, that was a relief to hear.

Although that brought me some peace, I felt angry and sad for all those who will never be able to afford such coverage or qualify for the cutting-edge, life-saving drug. What happens to them and their families? Do we shrug? Or say, who cares? Or say, oh well too bad for them? Or, there but for the grace of god go I? It’s no wonder more people are having trouble sleeping at night.

Earlier in the week, I read about an oncologist’s medical practice that pays over $350,000 a year on employees who spend all day battling with insurance companies over denials for patients’s prescribed procedures, tests, and medications. That’s all they do—argue. I wonder how well they sleep at night churning over the latest rejection and the related sick patient caught in the middle.

I learned that as a standard cost-cutting and delay tactic, insurance companies routinely deny each request right off the bat for one of countless bogus reasons. It’s up to the medical practice to fight the denials until the insurance company eventually relents. But often doctors in poor communities can’t afford to have someone doing that job. It’s up to the sick patient to fight his own battle.

There’s profit in delays and denials, and potentially a death sentence when it comes to cancer and other life-threatening diseases. As one doctor put it, for an insurer it’s cheaper to delay than pay.

So is anything being done to reel in the cost of drugs? Last week the Biden administration announced the first 10 of 50 medicare drugs to undergo cost reduction negotiations with the drug manufacturers over the next several years. The Drug Price Negotiation Program is part of the Inflation Reduction Act of 2022 (IRA), and the first group of drugs will reduce costs on treatments for diabetes, chronic heart failure, Crohn’s disease, and cancer. An overwhelming majority of Americans, both Republicans and Democrats, support the program, but it nevertheless faces legal challenges from Big Pharma. Big surprise.

There once was a widely accepted ethic in medicine: First, do no harm. But pharmaceutical companies are not required to take the Hippocratic Oath. Nor do they have any incentive to think outside the “make more profits” box. So anything goes, including the endless, frightening, potential side effects embedded in most of today’s latest drugs. Should they do better? Sure. But that would be less profitable.

Dennis is a very lucky man. He’s fortunate to have good insurance that covers him fully. Without it, he might not be with us today. The drugs have given him many precious extra years, and I expect will continue to do so. But for millions of less fortunate Americans, drug companies and insurers are knowingly doing harm by slamming their doors in their face, and that is an injustice no one should abide. I wish things were very different.

What then can we do? We can learn which of our legislators are focused on helping all Americans and which are sailing on yachts with babes, martinis, and profiteers. By learning who’s helping who, we can keep the good guys in office and boot the others to the curb. One quick way to learn who’s behind you and who’s not is to discover who supported the Inflation Reduction Act and who did not. Hint: All Democrats and Independents supported it, but not one Republican did.

If you’d like to learn more about the IRA that became law one year ago, check out this summary— https://www.mckinsey.com/industries/public-sector/our-insights/the-infla...

Well Street

Thank you for this important information, and I feel the same anger about the insurance companies' conduct. They're all about doing no harm—to their profit margins.

A physical therapist friend told me that for years, insurance companies have cut their costs by drastically reducing the number of PT sessions they'll approve for a patient. As a result, more clinics are becoming cash-based and avoiding the hassle of dealing with insurance.

Evangel

A chasm lies between humanity's needs and corporate wants. Other societies have been successful in meeting the needs and wants of both. We're not there yet.

Wonderland

From the first line in the attached link:
“The Inflation Reduction Act contains $500 billion in new spending”
I’m not pretending to know all that was in this bill, but I do understand why some legislators would be opposed to it. That is a pretty large number! The fact that ”all Democrats and Independents supported it, and all Republicans opposed it” is troubling in itself. We are a country divided, and I find that the partisan politics to be the biggest problem we are facing.

Evangel

You’re right. On the surface the 500 billion is large, but the costs are spread over five to ten years and reduce the nation’s deficit by 237 billion, whereas annually we spend between 700-800 billion on defense. Interestingly, the vast majority of the IRA money is being poured into red states.

You also make a good point about partisanship and division. It is troubling. Partisanship by nature is inherent in any democracy, but division is our karma. We spent decades sowing division in other countries for our personal gain, and now it’s come back to slap us in the face.

Slipstream

No medicine should cost a patient that kind of money. I bet that same medicine in Canada would cost $1.98 or maybe nothing. Let's face it, insurance companies have bought and paid for our politicians, and we, the patients, pay the price... sometimes with our lives.

Evangel

You know there's a lack of humanity in these companies when they refer to the insured as plebeians.

Wonderland

I agree 100%!!! The world's most expensive drug: Alexion Pharmaceutical's Soliris, at $409,500 per year, back in 2010. . I was diagnosed with PNH in 2010.(paroxysmal nocturnal hemoglobinuria) For those who could not afford it: (hi, me!!} NORD paid their way. I know NORD get funding from corporate grants and non profits, but someone is making a s***load of money. American pharmaceuticals are out of control. I agree about the cost of meds in Canada, but I also hear horror stories about seeing a doctor there.

Slipstream

Absolutely unbelievable! You are so fortunate that NORD paid for it. Thanks for sharing your experience.