Hero MD: “How do I tell my patient …?


What you're about to read happens all across the United States. Every day, American citizens and their doctors deal with crap like this and worse in the richest country on the planet.

My phone rang as it does many mornings. It was my dear friend, the surgeon and oncologist. His voice was more subdued than usual. I've discovered that his voice is a mirror into his soul.

"What's up?" I said, bracing for bad news.

"How do I tell my patient that she won't be getting the chemotherapy?"

"Won't be getting the chemotherapy? You've got to be kidding me." I stammered.

"It's been denied." My hero friend said, his voice choking back emotion. Yes, some/many doctors care. They are horrified by what they see day in and day out. They are revolted by the terminally ill healthcare system.

They know better than anyone that Murder by Spreadsheet is far too generous a characterization.

"How can they deny chemotherapy?" I asked again.

"It's expensive--it's way too expensive." He said.

"What the hell is it called?" I asked.

He put me on hold for a moment as he took a call from the hospital. I've learned to listen carefully as he speaks and process information in shorthand. I've also learned the right questions to ask.

He returned. "Another crisis, I've got to get to the O.R."

"So what's the chemotherapy that was denied?"


I scribbled down ABRAXANE, as he carefully spelled it.

"How much does it cost?" I asked.

"A fortune. We've tried all the alternatives, she ended up in the ICU, she can't tolerate the cheap stuff."

"What's the cheap stuff?" I asked.

"Taxane, Taxol, Taxotere." He said. (I may have the spellings wrong here)

After we hung up, I went to Google and carefully typed in ABRAXANE.

Here's what I found.

Abraxane (formerly ABI-007) is an old drug in a new package that promises to make chemotherapy less toxic and more effective for women with metastatic breast cancer.The old drug is paclitaxel, the active agent in Taxol and Abraxane. In a phase III clinical trial reported here, Abraxane produced a higher overall response rate (33% vs. 19%), higher tumor response (42% vs. 27% when used as a first-line treatment), and longer median time to tumor progression (21.9 weeks vs. 16.1 weeks).

Abraxane was also significantly less toxic, causing grade 4 neutropenia in 9% of women compared with 22% of those receiving Taxol in the 454-patient study presented in a special late-breaker session at the 26th Annual San Antonio Breast Cancer Symposium.

From the Abraxane web site.

nyceve's note: Abraxane is by no means risk free, I'm sure all chemotherapy carries myriad risks, it appears that
Abraxane has fewer risks or less horrific risks than the older, less expensive drugs.

Q: How does ABRAXANE differ from some other cancer treatments?
A: One of the most important differences between ABRAXANE and solvent-based paclitaxel is the lack of solvents. These solvents can cause side effects such as difficulty breathing, hives, swollen eyes and lips, a flushed face, and severe allergic reactions (hypersensitivity reactions), which is why patients also need to be pre-treated with steroids and antihistamines. Because ABRAXANE does not contain solvents, patients treated with ABRAXANE do not need to be pre-treated with these medications.
Abraxane is a controversail and expensive drug. It costs $4200.00 a dose. If your mother, sister, friend or grandmother had used the cheaper alternatives with much distress, don't you think in the richest country on the planet getting Abraxane should be a basic right.

Do you think Lynne Cheney would accept the cheap stuff?

Or Barbara Bush?

Or Elizabeth Dole?

Or Hillary Clinton?

Or Condi Rice?

I. Don't Think. So.

Am I crazy? Do you want your trusted doctor making the decision about what drug you'll get, or an insurance company clerk with a job description to deceive, deny and delay.

Carol Austin-Fink, who learned last year that she had cancer in her right breast, insisted on taking Abraxane after she received the diagnosis because the chemotherapy she received in 1996 for a different cancer in her left breast had caused severe side effects. The earlier treatment did not include Taxol, so she had no idea whether Taxol would cause problems for her, but she did not want to take the chance.

Ms. Austin-Fink, a 59-year-old writer who lives in Las Vegas, said she received six doses of Abraxane over four months, a standard course of treatment. The cost of the drug did not concern her because she has excellent insurance coverage, she said.

"My insurance company just paid it, because my doctors said they needed it, and the insurance company doesn’t argue with stuff like that," Ms. Austin-Fink said.

The Abraxane had few side effects and caused her tumor to shrink almost immediately. Her cancer has remained under control since her final treatment a year ago, she said. She said she believes that Abraxane worked better for her than Taxol would have, though she acknowledged that she could not be sure.

It might be a right, if healthcare dollars were not squandered and pissed away by the for-profit insurance industry and a system which rewards Wall Street at the expense of the American people.

The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 46 million without health coverage and millions more inadequately covered.

This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment though a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.


You'll be shocked at how this sad story ends.

Back in the hospital, three people are on various lines trying to get the insurance company to back down. This is what it takes in America. There's a freshly minted resident from India doing some post-graduate training in the United States watching the surreal scene.

He turns to the surgeon/oncologist and says, "you know doctor this is crazy, in India the patient would get this medication with one signature."

In India--one of the poorest countries on the planet. But not in the United States.

Or I suppose in the United States, many Americans (insured and uninsured alike) are charging medical care on their already heavily over-extended credit cards.

Based on data from a national survey of low- and middle-income households, the report said consumers who used credit cards to pay for medical expenses had much higher credit card debts than those who do not.

Specifically, the report said low- and middle-income households with medical debt carried an average $11,623 of credit card debt, compared with $7,964 for those without medical debts on their credit cards.

"Too many working people are piling up debt on high-interest credit cards and risking their financial security simply because they have the misfortune of getting sick," Mark Rukavina, executive director of The Access Project resource center and co-author of the report, said in a release.

Universal single-payer today, it's an American right.

NycEve: Author Bio | Other Posts
Posted at 10:00 PM, Feb 10, 2007 in Civil Justice | Health Care | Health Insurance | Insurance Industry
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Patient and doctor can thank the lawyer for this nightmare. It is the land pirate that gave the insurance company absolute immunity from accountability. No lawyer should be allowed to sit on any bench, in any legislature, nor in any executive policy position.

Posted by: Supremacy Claus | February 10, 2007 10:44 PM

I must say, I am extremely impressed with Eve. She is a generous person. A very generous person... with other people's money.

Posted by: David Nieporent | February 11, 2007 3:13 PM

Whaaaaaaaaaaaaaaaaaat, are you talking about, David?

It's our fragmented for-profit insurance industry, and the Wall Street ROI which accounts for something like 25-30 of the costs of healthcare.

A single-payer system (Medicare for all) with administrative expenses around 2-3% would be far less costly than the crap we have and we wouldn't have 48 million uninsured.

Why does logic and rationality scare you?

Posted by: nyceve | February 12, 2007 6:17 PM

A single-payer system (Medicare for all) won't have administrative expenses around 2-3%. Medicare doesn't even have administrative expenses around 2-3% unless you omit all the third-party administrative expenses.

But, more importantly for purposes of this post, in a world with single-payer, not only will Abraxane not be covered (how many of the European single-payer systems cover Abraxane?), but Abraxane wouldn't even exist, because there would be no incentive to invent it.

Posted by: Ted | February 12, 2007 8:32 PM

Leaving aside the imaginary statistics (hey, why not imagine administrative expenses of negative infinity percent on a program which also eliminates rainy days and litter, as long as we're in easter bunny land?), what does that have to do with your complaint, Eve, which was about someone being denied a particular drug?

Do you think a single payer system gives out every treatment to every patient who wants it? Do you think there's no rationing in a single payer system? Do you think government causes money to grow on trees?

Posted by: David M. Nieporent | February 12, 2007 10:24 PM

Oh, and by the way, Eve, thank you for this post, because when other leftists accuse drugs like Abraxane of just being an "old wine in new bottles" formulation of existing generic drugs (in this case Taxol) and evidence of the evil of pharmaceutical intellectual property, I'll point out to them this post that demonstrates that reformulations of existing drugs can represent real progress.

And, as I thought, Abraxane isn't even available in the EU, much less paid for by government tax dollars. Think about that, Eve, next time you call for US health to look more like the European model.

Posted by: Ted | February 14, 2007 6:49 AM

How single-payer cancer patients are treated in Scotland. This is what Eve MD wants for Americans.

Posted by: Ted | February 15, 2007 5:58 PM

Eve: No dialysis after 57 in England. It's Adios, for your 57th birthday. Without dialysis for a few days, the potassium rises, stops the heart. This is the method used to execute murderers in the US. In your socialist paradise, the murderer is safe, the renal failure patient is executed for his birthday.

Posted by: Supremacy Claus | February 16, 2007 3:41 AM

Eve: A scholarly review of health care rationing.

The description of Britain starts on p. 59. 6 of 10 Britons are dissatisfied. If you surveyed sick people, that fraction might be 10 of 10.

Posted by: Supremacy Claus | February 16, 2007 8:32 AM

Eve: If ever in England, don't get into any accident where bleeding results. The surgeons? The people that are just as good as ours? But, fought to make $90,000 a year? When ours are making three times as much? Well, they leave at 5 PM, on the dot, come hell or high water. So guess what? You are profusely bleeding from a torn artery that can be sewn up in 10 minutes? Guess what, the waiting on emergency surgery of that nature is 6 days.

Now, how can they keep you alive, until a surgeon gets around to your surgical emergency? They pump units of donated blood. That means you are getting many, many units in the 6 days of waiting.

Guess what? They have now fixed your bleeding artery. But now you have a souvenir from the 20 units of blood, AIDS. A remembrance of England that a real tourist told me about.

Have a nice day.

Oh, if you ever need elective surgery or an organ transplant in England? Ha. What are those?

Posted by: Supremacy Claus | February 16, 2007 7:16 PM

Eve: Yet another confirmation of the effects of socialism on living standards:

This wealthy nation is on its way to becoming another Zimbabwe, with a drop in life expectancy from 60 to 45, dropping further, due to starvation, in a lush, Eden like land.

Socialism is scarcity.

Posted by: Supremacy Claus | February 17, 2007 7:20 AM

We have so many problems in healthcare, the entire system needs to be rebuilt. A sweeping change to expand Medicare for all is not a simple fix-it. We will be waiting six months just to get a band aid. This also in no way addresses this issue of quality of care or efficiency, both of which are significant cost-drivers. We need to come up with a solution for sure, and many consumers are against socialized healthcare. What we need is a group of the right experts to assemble and study the entire system all the way back to medical school and develop solutions and implement them, period.

Posted by: Lisa Lindell | February 22, 2007 2:04 AM