A Brave New World - But Who Can Afford It?

The doctors' lunch table discussion on Thursday, Nov. 7, was a little different. Since the only oncologist in the group had left practice, we did not discuss the inability of oncologists to pay for an office stockpile of expensive chemotherapy drugs for their patients and the difficulties this caused for patients, oncologists, hospital and infusion centers to which these patients were referred for treatment. The difference yesterday that the complaint came from a new source, an experienced community nephrologist who described an insured kidney failure (not on dialysis) patient who need erythropoietin to produce blood. Because the doctor's practice was not generating sufficient income for him to stockpile a supply a erythropoietin, he gave the prescription to the patient whom he told to procure the drug and bring it in on the next visit. The patient came, but without the drug, saying that he couldn't afford the $500 prescription charge. This doctor went ahead and took care of the patient's need, giving him the medically appropriate dose of erythropoietin, but sent letters to the rest of his patients informing them that he will be unable to do this for them.

Recently, there have been studies and journal articles about the risks of giving too much erythropoietin. But less dramatic information about the difficulties patients are having in getting, paying for and benefiting from standard accepted medical therapies grab no headlines. As we move into a period of extraordinarily effective biologic products which relieve pain, suffering and premature death, our health system will have to grapple with the high costs of these products and their unavailability to many who need them.