Cancer Care’s Rationers

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WSJ Review and Outlook

The Lancet last week published the findings of its international 37-expert commission on “Delivering Affordable Cancer Care in High-Income Countries.” The prestigious British medical journal’s broadside against oncology’s “culture of excess” is drawing notice in medical circles and especially fevered attention in the land of the National Health Service. But readers interested in the medical options—or lack thereof—that ObamaCare will soon deliver should take note as well.

The report does observe recent advances in the fight against cancer, including one estimate that since 1980 “anticancer medicines increased life expectancy in the average patient with cancer by nearly 1 year, at a mean cost in the USA of $6,500.” If that sounds like good news, the report’s authors are less sanguine. Instead, their findings are long on laments that the “rapid development of new technologies” and other innovations are helping drive the world’s $895 billion-and-growing “cancer burden.”

The report does confront a vexing moral issue, and it makes nuanced concessions—about the tradeoffs between cost and innovation, for instance—that are unusual from the likes of the Lancet. By way of example, take the case of sipuleucel-T, one of a class of “molecularly targeted therapies” that “are revolutionizing the treatment of cancer.” Sipuleucel-T has been shown to improve survival by several months for patients with metastatic prostate cancer.

The authors lament that the therapy costs roughly $100,000 a head. “The treatment is proven to be effective,” muses the report, “but how shall we determine its value?” The report’s royal “we” returns again and again to such questions, claiming that “we overdiagnose, overtreat and overpromise.” And the main cure the report proposes lies not necessarily in more or better medicine, but in more allegedly enlightened forms of rationing and price controls.

The obvious answer is that “we” ought to have no business determining value, since the choice properly belongs to the patient, his family and care givers. But a government that puts itself, as Britain’s has, in the role of providing—and withholding—medical care must make such choices in the patient’s stead.

“Countries seeking to provide universal access to health care for all its citizens,” wrote the U.K.’s rationing body NICE in a statement accompanying the Lancet report, must consider the “opportunity costs often incurred by use of some expensive new anticancer drugs that offer modest benefits.”

Those choices are especially stark in Britain, which maintains one of the most comprehensive publicly funded health-care systems in the world. But the United States may not be far behind. The authors hope that ObamaCare’s various commissions will “lead to a wider application of cost-effectiveness based criteria for determining treatment entitlements in America.” They even recommend integrating cost-effectiveness with the Food and Drug Administration’s clinical approvals, along with tighter regulation of off-label drug use, which would be a disaster for terminally ill patients.

The reality is that cancer care accounts for merely 5% of total U.S. health spending, and making progress against one of the world’s leading causes of death is a leadership role that the world’s rich countries should be playing. Costs will come down and benefits will improve as genomic science allows doctors to better target therapies to subsets of patients.

One of the report’s co-authors, Karol Sikora of CancerPartnersUK, tendered an opposing view in a Daily Telegraph op-ed, writing that “society has to decide how much to put on the price of life.” A telling word that “society.” The tragedy of Britain’s socialized medical system, and perhaps soon of America’s, is that “society”—government—is now burdened by moral dilemmas that properly belong in the realm of individual choice.


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