ObamaCare: Why Avastin Matters

By
August 6, 2010

The FDA is considering designating the drug Avastin "off-label" for stage four breast cancer patients in the next few weeks. That doesn't mean patients won't be able to take the drug, it will simply determine whether or not they can afford to take it. As Big Government recently pointed out on the same topic, cost considerations are an increasingly significant factor when it comes to the government approving various health care options for Americans. And the trend under ObamaCare is only going to get worse.

Cost seems to be a particularly significant factor when it comes to Avastin and the breast cancer patients it may help. Who is better equipped to decide the value of either extending your life, or at the least, improving the quality of it until the end – you, in consultation with a qualified specialist who knows your case, or a room full of bureaucrats consulting manuals in Washington? That is the central question for me in this issue.

If allowed to continue, this trend is only going to get worse. How would you feel is you were fighting for your life against stage four breast cancer and could read this in the New York Times while knowing it was an option for someone with serious money, but not for you – even with health insurance?

Although only a handful of drugs tested in hundreds of individual trials have improved survival, patients who receive a diagnosis of advanced breast cancer today live on average about two or more years longer than 30 years ago. This is due in part to the availability of drugs that when used individually have modest effects, but when used sequentially produce incremental benefits.

In fact, Avastin did improve survival at one year for about 5 percent, or about 1 in 20 of those treated, although this early benefit was not maintained because of other therapies given later. We desperately need more therapeutic options, not fewer, and the pharmaceutical companies need to price them responsibly.

Joseph A. Sparano – director of Cancer Clinical Trials at the Montefiore-Einstein Cancer Center

When a drug is taken "off label" by the FDA it essentially denies coverage both through Medicare and through private insurance. Coincidentally, that's the situation with Avastin for ovarian cancer in Colorado right now and neither patients, nor doctors, are thrilled. By taking Avastin "off-label" for ovarian cancer, Medicare is denying patients the opportunity for life.

There is nothing like a genuine consensus where these various boards and lists come into play. Which experts do you want making your health care choices, some anonymous man, or woman, behind a desk in DC, or you and your doctor? I know which I'd choose.

Medicare contractors consult lists of scientifically reviewed drugs, called compendia, to determine whether to cover drugs for off-label use. The Medicare contractor for Colorado, TrailBlazer Health Enterprises, "is more conservative than the others" and consults four compendia, Fierberg said. One of the four did not support using Avastin for ovarian cancer because a clinical trial was terminated due to adverse effects, including serious bleeding.

Sen. Michael Bennet, D-Colo., has urged the Colorado Medicare office in a letter to push its contractor to cover Avastin.

A promising new drug to treat ovarian cancer is giving hope to women battling the ruthless disease, expected to kill 210 Coloradans and more than 14,000 other Americans this year.

For women who live in California or New York, Medicare pays for the monthly injections of Avastin — which can cost $7,000 to $15,000 apiece. Women in Colorado, meanwhile, are digging into retirement accounts or going without the drug because Medicare refuses to cover it here. The disparity has outraged Coloradans, who have asked federal lawmakers to fix it.

"I call that criminal," said Elaine Rueb, a Denver woman paying for her own Avastin injections. "It's just ridiculous. Medicare is a federal program, yet we have these regional rules that are different?" The reason Medicare rejects claims for Avastin in Colorado is that its contractor — the Dallas company that processes its claims — decided not to cover it. Absent a national coverage decision, and there isn't one regarding Avastin for ovarian cancer, local Medicare regions make their own coverage decision, said Mike Fierberg, spokesman for the Centers for Medicare and Medicaid Services in Colorado.  The U.S. Food and Drug Administration has approved Avastin for other cancers, including colon cancer. In the past couple of years, oncologists across the country started prescribing it "off-label" for ovarian-cancer patients.

Medicare contractors consult lists of scientifically reviewed drugs, called compendia, to determine whether to cover drugs for off-label use. The Medicare contractor for Colorado, TrailBlazer Health Enterprises, "is more conservative than the others" and consults four compendia, Fierberg said. One of the four did not support using Avastin for ovarian cancer because a clinical trial was terminated due to adverse effects, including serious bleeding. Sen. Michael Bennet, D-Colo., has urged the Colorado Medicare office in a letter to push its contractor to cover Avastin.

"It makes no sense that an ovarian- cancer patient can be denied access to this proven cancer drug just because she happens to live in Colorado," Bennet said. "All women should have access to these treatments, whether they live in Minnesota, California or Colorado." Annette McElhiney cashed in her savings to pay for four Avastin treatments in Colorado, spending close to $27,000.

Then the retired Metropolitan State College of Denver professor had two Avastin treatments near her winter retreat in Palm Desert, Calif., and mailed a fat check to the infusion center. When the clinic returned the money and told her Medicare picked up the bill, McElhiney was shocked and then "enraged" by the inequity. Now she travels to California every three weeks, using her husband's frequent-flier miles, for 30-minute Avastin injections. She's been in remission for six months and believes the drug is helping.  Dr. Susan Davidson, a gynecological oncologist at the University of Colorado Denver School of Medicine, has prescribed Avastin for several patients. A couple had private insurance that covered the drug, and a few got the drug manufacturer to subsidize the cost.  But several patients on Medicare are going without it.

"It feels like my patients are being discriminated against," Davidson said. "It's just unbelievably unfair. I can't understand why the policy for Medicare can't be uniform in this country."  Avastin works by inhibiting the growth of new blood vessels, which carry nutrients to a tumor. Rueb, who was diagnosed with ovarian cancer nearly four years ago, has had little break from chemotherapy since then. She is spending her savings on Avastin treatments, but that "won't last forever."  "You do run out of options after a while," the 59-year-old said. "It's pretty tough."

The same thing is now happening for breast cancer victims. This is the future of the American health care system under ObamaCare. Do you feel better, now?

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Comments:
  1. BrianA says:

    Anybody think this is not about money? Avastin is widely used by retina specialists for the treatment of wet macular degeneration. Avastin is not FDA approved for treatment of AMD but at a cost of less than $100 per dose, Medicare and other insurance companies will pay for the drug because the cost of the FDA approved drug for AMD, Lucentis, is $2000 per dose.

  2. Ragspierre says:

    Welcome to health care in the ObamaBanana Republic…
    “Alla you choices belongaus.”

  3. nishner says:

    If you’d actually read the story, it’s a PRIVATE CONTRACTOR, not the government, that’s making the decision. So I guess you’re complaint is the Big Government isn’t telling Private Contractors EXACTLY what to do. Is that a new plank of the Tea Bagger platform?
    And here’s another decision curtailing the use of Avastin — but it’s from 2009 — under President Bush.
    http://www.nytimes.com/2009/10/02/business/02avastin.html
    Oh yeah, did see this:
    “The annual checkup of the government’s big benefit programs for the elderly show that the Obama administration’s sweeping healthcare overhaul will extend the life of the Medicare hospital insurance fund by 12 years”

  4. Ragspierre says:

    nishner;
    You need to understand fascist economics. Clearly, you don’t.
    There will be private concerns involved in ObamaCare, as there always are in a fascist corporatist collective.
    Google will help you.

  5. nishner says:

    Look up fascism — it’s a frigging right-wing movement. Now Tea-Baggers, THAT could become a fascist movement.

  6. Ragspierre says:

    nishner;
    You are an ignorant idiot, as you’ve just shown.
    Fascism was a variant of Socialism. Mussolini was its author, and he was the head of the Italian Socialist movement.
    It’s German adaptation was National Socialism.
    The TEA Party movement is ANTI-totalitarian, while you Collectivists are PRO-totalitarian.
    Do some research. It might be painful, but it will enlighten.

  7. nishner says:

    Scholars generally consider fascism to be on the far right of the conventional left-right political spectrum.
    ..
    They oppose liberalism — as a bourgeois movement — and Marxism — as a proletarian movement — for being exclusive economic class-based movements.[
    http://en.wikipedia.org/wiki/Fascism
    *****
    Martial virtues are celebrated, while liberal and democratic values are disparaged. Fascism arose during the 1920s and ’30s partly out of fear of the rising power of the working classes; it differed from contemporary communism (as practiced under Joseph Stalin) by its protection of business and landowning elites and its preservation of class systems.
    http://www.britannica.com/EBchecked/topic/202210/fascism
    *****
    fascism [ˈfæʃɪzəm]
    n (sometimes capital)
    1. (Government, Politics & Diplomacy) any ideology or movement inspired by Italian Fascism, such as German National Socialism; any right-wing nationalist ideology or movement with an authoritarian and hierarchical structure that is fundamentally opposed to democracy and liberalism
    2. (Government, Politics & Diplomacy) any ideology, movement, programme, tendency, etc., that may be characterized as right-wing, chauvinist, authoritarian, etc.
    3. prejudice in relation to the subject specified body fascism
    [from Italian fascismo, from fascio political group, from Latin fascis bundle; see fasces]
    http://www.thefreedictionary.com/fascism
    *****
    fas·cist   [fash-ist] Show IPA
    –noun
    1. a person who believes in or sympathizes with fascism.
    2. ( often initial capital letter ) a member of a fascist movement or party.
    3. a person who is dictatorial or has extreme right-wing views.
    http://dictionary.reference.com/browse/fascist

  8. Ragspierre says:

    “…movement with an authoritarian and hierarchical structure that is fundamentally opposed to democracy and CLASSICAL liberalism…”
    dummy.
    “…it differed from contemporary communism (as practiced under Joseph Stalin) by its protection of business and landowning elites and its preservation of class systems.”
    Sounds familiar, right?
    Fascist economics is characterized by the corporatist collective, consisting of private business, organized labor, and government with ultimate decision-making power. It is inherently anti-entrepreneurial and anti-market.
    The ObamaCare plan. The GM plan. The Chrysler plan.

  9. nishner says:

    That’s stupid, really. The government’s is going to sell its GM stock, not acquire more. It stepped in to save GM in an extraordinary economic melt-down. Course TeaTards are so blinded by their BS ideology, any attempt at critical thinking fails.
    The government is going to SELL its GM stock. Duh.
    As for Health Care Reform, there’s no Government Takeover. Your doctor still works for the same hospital / clinic / whatever as before.
    Oh yeah, since your a Wing Nut, there’s NO DEATH PANELs.

  10. Ragspierre says:

    A closed mind is a terrible thing…and yours is a WASTE.
    The reality just bounces right off, doesn’t it?
    Actually, there ARE Death Panels at work right now. Look into the states with their own health care plans.
    They are just an inevitable certainty when governments make choices instead of people or families making decisions.
    GM and Chrysler could have undergone reorganization via a REAL bankruptcy. I known, since I practice in bankruptcy court. It happens every day. Ever hear of Enron?
    GM and Chrysler will NEVER be free of government decision-making…until the people take back their government.

  11. nishner says:

    I guess I’ve lost track of the TeaTard position on Medicare. One day, they want to do away with it. Next day they bitch because Big Government isn’t spending enough on it.
    And no, THERE ARE NO DEATH PANELS choosing to let one person live, another die. But private insurers have denied treatment, denied coverage, kicked people off their polices, etc. Those are your REAL Death Panels.
    Enron went bankrupt when the economy was doing fine – remember, Clinton left Bush a BUDGET SURPLUS, instead of the disaster Bush left Obama. A GM bankruptcy, when the economy was already teetering might have tipped it into depression. And it would have certainly taken down a lot of its suppliers with it. And it’s ridiculous to compare Enron to GM — you can’t move energy production / distribution to Japan / Korea / China.
    “GM and Chrysler will NEVER be free of government decision-making…until the people take back their government.”
    They’ll be private someday. But they’ll always be subject to government regulations — seat belts, air bags, pollution controls, etc. are all for the good. The save lives instead of making your care a Death Trap.
    “until the people take back their government.”
    Get better candidates with better ideas instead of loons like Paul, Angle, etc.

  12. Ragspierre says:

    “And no, THERE ARE NO DEATH PANELS choosing to let one person live, another die. But private insurers have denied treatment, denied coverage, kicked people off their polices, etc. Those are your REAL Death Panels.”
    You’re such a tool for the Collective that you don’t know that PRIVATE insurers do that LESS than do the Federal programs ON THE GROUND NOW.
    The state programs to which I referred…and you ignored…ARE deciding who will live and who will die. The facts are readily available to anyone with a brain. Which leaves you out, by your own choice.
    Your comments on the car companies are stupid excuses…and nothing more. They fly in the face of reality in bankruptcy law and economics.
    But thank you for the opportunity to illuminate your idiocy!!!

  13. nishner says:

    Executives of three of the nation’s largest health insurers told federal lawmakers in Washington on Tuesday that they would continue canceling medical coverage for some sick policyholders, despite withering criticism from Republican and Democratic members of Congress who decried the practice as unfair and abusive. [...]
    An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.
    It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.
    ****
    Late in the hearing, [Rep. Bart Stupak (D-Mich.)], the committee chairman, put the executives on the spot. Stupak asked each of them whether he would at least commit his company to immediately stop rescissions except where they could show “intentional fraud.”
    The answer from all three executives: “No.
    http://articles.latimes.com/2009/jun/17/business/fi-rescind17

  14. Ragspierre says:

    “According to the American Medical Association’s National Health Insurer Report Card for 2008, the government’s health plan, Medicare, denied medical claims at nearly double the average for private insurers: Medicare denied 6.85% of claims. The highest private insurance denier was Aetna @ 6.8%, followed by Anthem Blue Cross @ 3.44, with an average denial rate of medical claims by private insurers of 3.88%
    In its 2009 National Health Insurer Report Card, the AMA reports that Medicare denied only 4% of claims—a big improvement, but outpaced better still by the private insurers. The prior year’s high private denier, Aetna, reduced denials to 1.81%—an astounding 75% improvement—with similar declines by all other private insurers, to average only 2.79%.”
    Hmmm….
    The market beats BIG GOVERNMENT. Wow. Just like I said.
    See, that isn’t about some Collectivist creep bullying insurance execs for the cameras.
    And, being a trial attorney, I sue insurance companies who violate contracts.
    I’ll give you a clue about the odds of suing the ObamaCare system successfully… 0

  15. nishner says:

    Got any info on WHY the claims were denied?. You may have missed it, but there’s a fair amount of fraud perpetrated on Medicare. Were the claims denied for a valid reason, such as faud? How many were denied for paperwork or other errors, appealed and approved? And Medicare basically covers everyone over 65, the sickest population segment, while commercial insurers cover a healthier sergment.
    ******
    Course if you ask the people, they actually like Medicare better than private insurers:
    “The Commonwealth Fund/Health Affairs study compared the experiences of elderly Medicare beneficiaries with those of people under age 65 with employer-based, private health insurance from 2001 to 2007.
    Even though Medicare beneficiaries were older and sicker, their experiences were better across the board, with better access, higher-rated quality of care, fewer problems with medical bills, and higher satisfaction with coverage at lower cost.
    The HHS commissioned survey in June also cited substantially higher satisfaction among Medicare patients than among those with private insurance — 56 percent of enrollees in traditional Medicare give Medicare a rating of 9 or 10 on a 0-10 scale, compared to only 40 percent of Americans in private plans.”

  16. Ragspierre says:

    Yeah, The Commonwealth Fund is an honest broker. Sure. Liar.
    But, you point is…what? That HHS can dummy up a survey? Whoa…!
    I mean, I’ve proven up everything I’ve told you.
    You just come back with new BS. NEW BS…
    And you’ve never had the integrity to look up what I’ve told you, and fess up when I proved what I said. (Like the existence of Death Panels currently.)
    Waste of time.

  17. nishner says:

    Saying something over and over and over doesn’t make it so.
    Existence of Death Panels is on par with those who believe the the Earth is Flat. That the Moon Landing was filmed in Hollywood. That 9/11 was an Inside Job. That Obama’s a Socialist. That Obama wasn’t born in Hawaii.
    Or, in English. total, unadulterated Bullsh**.

  18. bobmontgomery says:

    Yes, I believe these are what Sarah called “Death Panels”. And I believe we will be saying it over and over and over….because it is so. And no, Obama is not a Socialist, he’s a wannabe dictator.
    Oh, and by the way, dear nisher, insurance companies are going defunct, insurance companies are changing their policies, taxes are being raised on those making less than $250k, the CBO’s designation of Obamacare as deficit-neutral was based on faulty premises, lies and propagand ….that also is so. And we are going to keep saying it…..over and over and over again.

  19. nishner says:

    Sarah Palin, you mean the former half-term governor of Alaska. The Pit Bull who couldn’t hack it? The “Grizzly” that quit mid-term.
    I now it’s useless to try to educate someone who’s mind is so rigid, but here ya go:
    “Of all the falsehoods and distortions in the political discourse this year, one stood out from the rest.
    “Death panels.””
    http://www.politifact.com/truth-o-meter/article/2009/dec/18/politifact-lie-year-death-panels/
    As for the insurance industry, you may want to check their financials.. They’re doing pretty damn well.
    Obama wants to be a dicator — that’s hilarious. As for the rest of your post, calling it BS would be kind. Delusional would be closer.

  20. Ragspierre says:

    This idiot nishner believes in free goods being infinite. Hence, no rationing by “Death Panels” under government-run health care, in the face of evidence from all over the world, Oregon, Washington, and Massachusetts.
    He/she/it also believes in “efficient government”; that utterly unaccountable government bureaucrats will make better decisions for your health care than will you; that people with a profit motive are somehow bad as compared to DMV-types; and that a profit margin in the single digits is “doing pretty damn well”.
    He/she/it refuses to consider that certain CRONY-PICKED BIG BUSINESSES WILL do well in a fascist economic system, as they historically have in this country and in others.
    This is the result of real delusion.

  21. russ says:

    Obviously the ‘nishner’ will do his/her level best to avoid the facts since the facts undercut the inane position the ‘nishner’ is pedaling…
    I guess the ‘nishner’ never bothered to look at the recess appoint of ‘I admire death panels Berwick…
    What I found hilarious is the ‘nishner’ thinks the New York Times is a credible source of information…

  22. tom swift says:

    My, my. Isn’t it about time for responsible adults to drop the old fantasy that Clinton “left budget surpluses”? The Clinton era was notable for, among other things, the nefarious practice of moving economically embarrassing items “off-budget.” This was regarded as a clever innovation, but all it really did was hide some catastrophic spending, and allow the pretense that the budget was balanced, or had surpluses. It was, like so many other things Clintonian, a con. The real numbers showed up in the constantly-increasing national debt. If the debt constantly increases, it’s because the government spends more money than it takes in, and must borrow (that is, increase the debt) to cover the difference. This is true no matter what the official budget seems to show.
    The US debt has been growing monotonically since the 1960s, when the government started behaving like a teenager with her first credit card. There were two years during the Clinton administration when the annual increase in debt almost leveled off; that is, government expenditure was almost matched by government revenues. The curves for deficit and debt still showed increases, but much less than the years before or after. However, it’s contentious to credit those few years to Clinton. They correlate better with the years when the government was dominated by the Gingrich congress. Bush, all can agree, spent too much money, though unlike Clinton, he did have something to spend it on, like a war.

  23. Shtetl G says:

    I have seen the future and it is happening now. I work at a retail pharmacy doing Medicare billing. Our pharmacy has a relationship with the local cancer center and we handle a lot of Rx’s for Xeloda, a anti-cancer medication that we bill through Medicare Part B (for some reason this drug is not covered under part D the prescription benefit). On June 1 st Medicare stopped paying for this drug for patients that have pancreatic cancer. The treatment of pancreatic cancer is an off label indication for Xeloda. They are doing tests and hope to have an official indication by 2011. I know the medication is helping because our customers are coming back for their refills (no mean feat for pancreatic cancer). I am currently appealing the decision with medicare which takes 90 days. I tried to expedite the appeal but that seems to be impossible with Medicare (I spoke to very un-sympathetic medicare supervisor who when I mentioned that pancreatic cancer is one of the worst cancers you can get and time was of the essence, told me all cancer is bad). Thankfully the manufacturer (genetech) is supplying the drug for free while the appeal is going on. Did I mention that a month supply of Xeloda costs thousands of dollars? Medicare not covering Xeloda for pancreatic cancer is a win win for the government as they save for the medication and for any future benefits as the patients die quickly. Don’t fool yourself, government bureaucrats are making life and death decisions now.

  24. Fred Z says:

    I live in Alberta, Canada. We have had government funded medicare for a long time.
    The system is broke and getting more broke, both financially and physically. Infinite demand versus finite supply just does not work, snarky folk like nishner notwithstanding.
    Nishner, there are no “Death Panels”. They are “Treatment Panels”, or “Therapy Selection Committees” or “Triage Directors”. So that’s OK then, right, if nishner gets triaged down to getting surgery last, say 3 years from now and the surgery he gets is one selected by someone else, a group of notable incompetents, probably drunk too, and the drug therapy his doctor wants was rejected by the Therapy Selection Committee as ‘unnecessary and too expensive’.
    Alas, poor nishner, he didn’t survive, but yet he smiles, because there was no Death Panel.
    Close your eyes and call up a vision for me. A vision of big-assed hippo people at the DMV, galumphing ponderously and slowly from desk to counter, rousing from the their stupid torpor only to bark at you and tell you that your papers are definitely not in order and you must go back to the start of the line.
    They are going to be in charge of your lives and your papers will never, ever, be in order.

  25. Ragspierre says:

    Excellent domestic models for government health care are the Health Services on Indian Reservations, and the VA.
    Neither a case-study in customer satisfaction…

  26. Rick Caird says:

    nishner, and the left in general, need to believe fascism is a political system coming from the right. It is not. It is from the left and follows in the traditions of socialism and communism. It is simply a variant, but not essentially different from the other two. nishner needs desperately to believe fascism is from the right so as to counter the notion socialism is not always socialism. In essence, he needs a talking point even if he does not understand it.
    The basic idea behind fascism, besides being a dictatorship, is the government will control the means of production not by ownership, but by control over the owners of the means of production. That is, by definition, socialism. The result is the same. A dictatorship from the right is one like we see in Iran. It has no interest in the means of production, but pursues some ideology like religion. nishner and others like him want to wave away the very fact Nazis even called themselves “socialist’ in their name. We suppose nishner knows more than the Nazis as to who they were and what they believed. It was the same with Mussolini. Mussolini could not make the “trains run on time” unless he controlled the trains. The whole idea Mussolini espoused was to “cure” the defects of capitalism via state control.
    It is very similar with GM. No rational management would develop a car that went a mere 40 miles between “fillings” and cost $41,000. There are two reasons GM did this. The first was to curry favor with the current government and to reward government for the bailout. The second is because GM knew they could get government to subsidize the purchase of this white elephant car by taking some of the purchase money from other taxpayers and giving it to GM. That, in fact, is fascism. Government has directed GM to alter their manufacturing to conform to government’s wishes (or commands).

  27. Mike G says:

    “Scholars generally consider fascism to be on the far right of the conventional left-right political spectrum.”
    Right, because fascism is a total state led by a supreme leader with a personality cult for the benefit of a small elite with anti-Semitic tendencies…
    and leftist regimes like Stalin’s were totally the opposite!

  28. ThomasD says:

    Nishner’s own links clearly defined fascism as something originating with Mussolini, yet he somehow cannot grasp the fact that Mussolini was a committed leftist till the day he died.
    “All within the state, nothing outside the state, nothing against the state.”
    “The keystone of the Fascist doctrine is its conception of the State, of its essence, its functions, and its aims. For Fascism the State is absolute, individuals and groups relative.”
    “Fascism should rightly be called Corporatism, as it is the merger of corporate and government power”
    “The truth is that men are tired of liberty.”
    All quotes from Mussolini.
    Not sure what planet it’s been living on, but here on earth the fascism = right wing lie has been thoroughly unmasked.
    So tell me, who is that is protesting against an ever expanding Federal government? Who is it that wants to shrink the Federal behemoth? Who has been opposing the Wall Street and Big Auto bailouts? Who has been trying to stop the Fed’s takeover of the healthcare industry? Who talks about restoring liberty and letting the people manage their own affairs?
    Certainly not you, and certainly not Obama, who has only sought to aggrandize the Federal government at the expense of the States and the People, and who has sought to bring ever more of the private sector under government control – if not outright ownership! Fascist indeed.
    Obvious liar is obvious.

  29. Ragspierre says:

    It also bears remembering that Nazi Germany was all about universal health care, against smoking, promoted vegetarian diets, deplored processed food and efficient agricultural as “impure”, and a “living wage” for the volk.
    Mussolini coined the term “totalitarian”, and he meant it as a benevolent notion; everybody was part of the Collective. Now, the Collective uses the term “comprehensive” to mean the same thing.
    Can’t have that “individuality” stuff happening out there…

  30. TMLutas says:

    Even if you can afford any treatment and have no insurance you would not limit your consideration of treatment to just the medical discussion with your doctor. Your financial team would come into play as questions of bankruptcy, how much this is going to impact your estate, etc. are going to affect your decision. And in that discussion, if your sole heir starts getting creepy and talking down all the expensive treatments, you have a problem.
    Putting insurance into the equation doesn’t change the conversation. It just adds a large cast of characters to the discussion and some extra money that you don’t control. The possibility of somebody going creepy and acting in their own best interests but not yours is still there. In fact, the more distant the 3rd parties, the more likely it’s going to happen. Add in the government and the chance explodes.
    The FDA and Medicare are acting like the creepy heir on the make and there are a lot of people who sense it without being able to articulate it. Nobody can *prove* anything, but the vibe is not good.

  31. Ragspierre says:

    “And in that discussion, if your sole heir starts getting creepy and talking down all the expensive treatments, you have a problem.”
    Actually, THEY have a problem!!! I’d have no compunction about cutting them off at the knees.
    But try that with your Federal government…

  32. nishner says:

    It also bears remembering that Nazi Germany was all about universal health care, against smoking, promoted vegetarian diets, deplored processed food and efficient agricultural as “impure”, and a “living wage” for the volk.:
    So fu***** moronic it’s not even worth the effort to try to explain why it’s moronic.
    You apparently forgot where the Death Panel BS came from. Considering you’re a TeaTard sycophant, not surprising.
    Let me help:
    One iteration of Health Care reform include a provision to pay for VOLUNTARY consultations with professionals on whether to authorize aggressive and potentially life-saving interventions later in life. The original proposal even came from a REPUBLICAN.
    Now, in the brain-addled world of TeaTards, voluntary consulations became Death Panels.
    DId I menation TeaTards are frigging morons. And that includes Queen TeaTard, Ms. Quitter and former Half-Term Governor Sarah Palin.

  33. Rick Caird says:

    So, nishner must be giving up. He has descended into the leftist’s favorite realm: name calling.
    Actually, when we look at Socialist dictatorships, they are all about controlling the actions of the serfs. No dictatorship from the right is concerned about health care or diet. I suppose there could be a dictatorship concerned about vegan ideology, but that hasn’t happened yet. A dictatorship from the left is always concerned about justifying its dictatorship by ostensibly caring about the serfs.
    Anytime you have a state controlling health care, you have rationing because the state is concerned with cost and can determine what is a nd what is not appropriate care. In fact, that was the whole point of Dan’s post. The government is only concerned with the off label use of Avastan because it is paying for it and the government gets to make the rules. Denying off label use of Avastan is, in fact, a death panel if Avastan works in those cases. Dan has shown it has. So, to deny that death panels exist requires “the willing suspension of disbelief”.

  34. Ragspierre says:

    One of the American presidents fondest of fascist economics was Mr. Nixon.
    nishner is such a boob he/she/it has not studied the difference between CLASSICAL liberalism (which gave us the individualistic impulse of the Founding), and the corrupt torturing of “liberal” by the Collective (which is antithetical to individual liberty and choice).
    It does not get that fascist economics is particularly seductive, partly because it APPEARS to most people as allowing for private control of capital.
    As in the Nixon and FDR era wage and price controls.
    And, yes, Rick… It is reduced to sputting name-calling, rather than doing a little learning.
    And, I’ll bet it votes…

  35. tom swift says:

    Nixon’s price controls weren’t mandatory.
    The Carter era control of gasoline prices was mandatory, and we had shortages. For some odd reason, some people were surprised by this.
    Obama’s control of health care will also result in shortages. And again, some people will be surprised. Or pretend to be surprised.

  36. Ragspierre says:

    “Nixon’s price controls weren’t mandatory.”
    Not to be confrontational, but there’s just no such thing as a non-mandatory wage or price control.
    http://www.econreview.com/events/wageprice1971b.htm
    Nixon’s tampering in the oil and gas markets extended until Reagan reversed course (implementing a Carter intention), and the rest is history.

  37. nishner says:

    So, to deny that death panels exist requires “the willing suspension of disbelief”.
    You keep conflating other issues with the original Death Panel issue which dealt solely with end-of-life counseling. Try leaving the goal posts in one place for a while. Duh.
    You can take pretty much any drug and find someone, somewhere that swears it cures cancer, ALS, Aids, baldness, whatever. There’s an approval process for drugs with drugs looked at rigorously, not decided by cutting and pasting third party testimonials on the wonders of the drug. You think you’re an expert, apply for a job on the board. As far as I can tell, your expertise extends to taking the word of a Wing-Nut blogger that some drug should be approved when experts in the field, after months of STUDY, don’t agree.
    Course Tea Partiers are pretty much solidly against science.
    Nixon was a conservative Republican, at least at the time. Like most other conservative Republicans of the past century — Nixon, Eisenhower, the Republican Senators who helped pass Civil Rights legislation, probably even Reagan, they’d be Rinos to today’s Tea Baggers.


  38. One of the diagnostic efforts being made is the study of tumor tissue markers an genetic patient characteristics which might indicate whether or not a treatment like Avastin (bevacizumab) is likely to have a beneficial impact upon that patient’s condition.
    The use of this monoclonal antibody (mab) in treating metastatic breast cancer has been proven in cases where tumor cell evaluations have shown that human epidermal growth factor receptor 2 (HER2/neu [also known as ErbB-2]) testing is negative.
    But that doesn’t say much about the patient’s own natural physiological abilities to tolerate Avastin or to benefit from it. Individual human genetic characteristics look to have a tremendous effect on choosing the best treatments for any number of diseases, but not enough is yet known to help reliably steer patients with different kinds of cancer to the best treatment plans.
    The point here, however, is that politically controlled cancer research tends not to pursue the most likely lines of success. Politicians throw taxpayer money at whatever promises to buy the politicians the most popularity, and that makes for “science” the way Barney the Dinosaur makes for “music.”
    Hate them or not, the big pharmaceuticals companies are the ones who are doing most of the funding to expand the use of drugs like Avastin. They have the incentive, after all. They also very much want to find new drugs for the treatment of cancer, and ways to make those drugs maximally effective.
    But with Obamacare, those pharma manufacturers are not making long-range plans. Companies like Pfizer are presently sitting on megatons of cash, reluctant to put it into research and development because they simply don’t like the looks of what Barry Soetoro and his little ACORN elves are doing to the 17% of America’s gross domestic product in which the pharmaceuticals industry makes its living.
    It’s called “fear, uncertainty, and doubt” – good old FUD – and Barry has inflicted a whole lot of that upon the nation since he slimed into the White House, hasn’t he?

  39. tom swift says:

    Probably so. At least Nixon CALLED them voluntary.
    I wasn’t setting any wages or prices in those days, and don’t how it was handled by those who were.
    But they all tamper with markets, usually via taxes or subsidies, or a bit more subtly, with such things as student loans. It may be a bit of a stretch to call this tampering fascism, though. In the Spanish model, fascism probably resulted in a considerable liberalization of at least some portions of the national economy, compared to the preceding Republican (ie, communist) program. The Italian and German models were more economically authoritarian than the Spanish.

  40. Ragspierre says:

    “You keep conflating other issues with the original Death Panel issue which dealt solely with end-of-life counseling. Try leaving the goal posts in one place for a while. Duh.”
    No, Binky, that’s your little trick. Your first post asserted this move on the drug was private, remember?
    I have a hard science background. I INSIST on rational thinking, which is a damn sight different than you, or THE MAD KING BARACK with his unicorn engineering, “flaccid power” that will get millions killed, and over-weening ignorance of any number of other fields.
    Nixon was NOT a conservative…in any time. Conservatives understand and support market economics, a color-blind society, individual liberty, free speech, etc.
    People who love liberty are who they are…in any time. Collectivist thugs are who they are…in any time.

  41. nishner says:

    “I have a hard science background. I INSIST on rational thinking, which is a damn sight different than you,”
    Really? But you take the word of this blog over the FDA? Now THAT’S a great example of rational thinking.
    Background in Tea Bagger BS is more likely.
    “People who love liberty are who they are…in any time. Collectivist thugs are who they are…in any time.”
    “Collectivist thugs”. Geez talk about irrational.
    http://findarticles.com/p/news-articles/charleston-gazette-the/mi_8022/is_20100721/avastin-study-benefits-fda-panel/ai_n54515422/
    WASHINGTON – Federal health advisers said unanimously Tuesday that a follow-up study of the Roche drug Avastin failed to show meaningful benefits for breast cancer patients.
    A Food and Drug Administration panel of experts voted 13-0 that the risks and side effects of Avastin outweighed its benefits when used alongside the chemotherapy drug docetaxel.
    *******************
    A new Avastin study has confirmed the cancer drug’s link with serious, life-threatening gastrointestinal perforations. According to researchers at Stony Brook University Medical Center in Long Island, New York, people taking Avastin developed such perforations – holes in the gastrointestinal tract – at twice the rate that occurred among patients not taking the drug. Avastin already bears a Black Box warning on its label regarding its association with gastrointestinal perforations.
    http://www.newsinferno.com/archives/6338
    ***************
    http://www.webmd.com/breast-cancer/features/avastin-breast-cancer-treatment
    But there was no difference in what both oncologists and women with breast cancer see as most important: overall survival. Women taking Avastin did not live any longer than those only taking Taxol. That’s why the FDA’s decision in February was a bit of a surprise.
    “As much as we try to be driven by science and evidence, if there’s any possible advantage that can be given to the patient, we want to do it,” says Yelena Novik, MD. Novik is medical director of the clinical trials office of the New York University Clinical Cancer Center at NYU Cancer Institute.
    ***************
    A drug that got preliminary approval for treating breast cancer could see that approval reversed after an FDA meeting Tuesday, on the heels of two studies with discouraging results.
    ***************
    The results of those studies – known as AVADO and RIBBON1, respectively – were a major disappointment. In both trials, patients on Avastin went longer before symptoms worsened, but it didn’t translate to better survival. In the end, patients on standard drug therapies actually lived longer. Researchers also noted more side effects in the Avastin group, including high blood pressure, fatigue and loss of white blood cells.
    http://pagingdrgupta.blogs.cnn.com/2010/07/20/d-day-for-once-promising-breast-cancer-drug/

  42. Basil Seal says:

    “In both trials, patients on Avastin went longer before symptoms worsened, but it didn’t translate to better survival. ”
    That sounds like something that a patient might reasonably chose: the opportunity to delay the onset of severe symptoms so as to have more time with family and loved ones as well as get affairs in order. Even if the mortality is not delayed. Seems like the sort of distinction so many folks worry that bureaucrats might fail to make.

  43. Ragspierre says:

    “Really? But you take the word of this blog over the FDA? Now THAT’S a great example of rational thinking.”
    I don’t take much of anything on one source.
    Funny, this all appears new to you, too, Binky. You never raised this before, huh. That research session paid off, it appears.
    IF clinical trials show any drug is worthless…or worse, that is fine. Maybe Avastin is a stinker. Maybe not.
    On the other hand, your vaunted FDA keeps lots of drugs away from Americans that are known to be safe and effective elsewhere (like that hell-hole of wild-ass laissez-faire capitalism the EU). And ObamaCare will keep many drugs that would have been developed off the market, for the reasons already cited above. That means people will live shorter, more uncomfortable lives…and not just here. Everywhere.
    Way to go, Collectivist.
    Here’s a simple truth.
    BIG GOVERNMENT ruins.
    Markets innovate, and improve the standard of living.

  44. nishner says:

    Komrade:
    “I don’t take much of anything on one source.”
    Apparently you did, cause you originally wrote:
    “Welcome to health care in the ObamaBanana Republic…
    I know, I know, it’s not fair to actually use your own statements to show what a tool you are. Kinda the whole I was for Avastin before I was against it. But then you are a Rational Thinker and Master of Hard Science. So just because you’ve changed your positon 180 and apparently can’t manage to figure out how to use Google, I guess we shouldn’t hold your blatant contradictions against you.
    PS. Careful with that Internet thing. Big Government started it.
    Since you appear to be Google Challenged, here’s the search link: http://www.google.com/search?client=safari&rls=en&q=DARPA+internet&ie=UTF-8&oe=UTF-8


  45. Having proximal experience of encounters with the bureaucrats of the federal FDA, I am disinclined in the extreme to accept any ukase of the Food & Drug Administration as wholly reliable. Such utterances are political first and last, and therefore suspect at all times.
    In medicine as in everything else, I’m mindful of Jefferson’s admonition:
    “Were we directed from Washington when to sow and when to reap, we should soon want bread.”
    People in civil government are automatically suspect in their competence, their knowledge base, and their motivations. No other attitude toward these thugs (remember, their power comes entirely from the government’s functional monopoly on the retaliatory exercise of deadly force) is appropriate.
    Regarding the potential and actual adverse events in therapy with Avastin (bevacizumab), what kind of blithering idiot undertakes the use of any monoclonal antibody (mab) treatment agent without awareness of the longstanding history of potential side effects with these large-molecule biological products?
    The harping about increased rates of intestinal perforations among study subjects treated with Avastin (elucidated in the AVADO trial) is contemptible. The news of this phenomenon didn’t come as much of a surprise to anyone knowledgeable about Avastin or the cytotoxic chemotherapeutic agents used in concert with Avastin in the AVADO and RIBBON 1 trials.
    In fact, both AVADO and RIBBON 1 demonstrated that the use of this monoclonal antibody agent with commonly used “legacy” chemotherapies (Taxane, the anthracyclines, or capecitabine) increased the longitudinal survival of subjects in the Avastin-plus treatment arms, who showed less increase in tumor bulk or metastasis (cancer spread) when compared against the results obtained with the chemotherapeutic interventions absent Avastin therapy.
    The adverse events encountered in both RIBBON 1 and AVADO were reported to have been consistent with previous experience in prior Avastin trials. No NEW red flags were raised.
    This is something to get hysterical about?
    How about we accept the notion that if a participant in this exchange doesn’t know what the acronym “ASCO” signifies, he should just shut to hellangone up and quit posting?

  46. Basil Seal says:

    “PS. Careful with that Internet thing. Big Government started it. ”
    Up to a point, Lord Copper…
    Intel developed the first mircoprocessor chips in the 60′s that led to the personal computer in the 70′s. Think Gates and Jobs.
    The Army adopted TCP/IP for its networks but it didn’t invent it.
    Berkeley put TCP/IP in its Unix implementation which was widely distributed to higher eds and research institutes.
    HTTP was basically the creation of one person working in Europe.
    And the web you know today is basically the product of millions of individuals doing their own thing.

  47. Ragspierre says:

    “Welcome to health care in the ObamaBanana Republic…”
    I proudly repeat.
    http://www.americanthinker.com/2010/08/the_deadly_pact_how_obamacare.html
    “PS. Careful with that Internet thing. Big Government started it.”
    Gawd, what an idiot! The MILITARY = Big Government…!?!?!? You HATE the military, puke!
    How does it feel to be on the side that will kill millions, and consign millions more to pain and needless suffering?
    BIG GOVERNMENT ruins.
    Markets innovate, and raise the standard of living.

  48. Ragspierre says:

    “Now, adding to the insanity, there is ObamaCare.
    Every year, we negotiate a renewal to our health coverage. This year, our provider demanded a 28% increase in premiums—for a lesser plan. This is in part a tax increase that the federal government has co-opted insurance providers to collect. We had never faced an increase anywhere near this large; in each of the last two years, the increase was under 10%.”
    http://online.wsj.com/article_email/SB10001424052748704017904575409733776372738-lMyQjAxMTAwMDAwODEwNDgyWj.html
    Oh, and EITHER Obama is willing to manipulate people by lying about Americans dying by the thousands if his plan was not passed, OR
    He is willing to kill thousands by putting off implementation for YEARS out of crass politics.
    Sweet…

  49. Ragspierre says:

    http://hindenblog1.blogspot.com/2010/08/burn-f-word-watch.html
    Just another sharp splinter in your vile little heart, nish-feratu.

  50. nishner says:

    “How about we accept the notion that if a participant in this exchange doesn’t know what the acronym “ASCO” signifies, he should just shut to hellangone up and quit posting?”
    Does that apply to the owner of this blog – the OP of this thread – as well?
    I agree, domain experts should be given special consideration. Course that doesn’t apply when Wing Nuts deal with evolution, global warming, etc. In those cases, domain expertise is something to be mocked.
    Vinton Cerf, the guy most likely to be named Father of the Internet, and one of the architects of TCP/IP, worked at Darpa.
    And CERN, where Tim Berners-Lee invented the WWW, is another of them dang Big Government Can’t do Anything Right places.
    Yeah, the Defense Department is part of Big Government. They get hundreds of billions of dollars of your tax dollars every year.
    As for your other posts, more of the same tripe.
    The problem with the US health system is we pay way too much – 40% or more than any other country in the world without a commensurate return on hour total health care.
    # 1 United States: $4,631.00 per capita
    # 2 Switzerland: $3,222.00 per capita
    # 3 Germany: $2,748.00 per capita
    # 4 Iceland: $2,608.00 per capita
    http://www.nationmaster.com/graph/hea_hea_car_fun_tot_per_cap-care-funding-total-per-capita

  51. Basil Seal says:

    Nishner,
    You’re missing the point as is so often the case when someone is overly impressed with his own, mostly imaginary, cleverness. Do try and keep up, won’t you?
    There was no government program to create the Internet as we know it. It is the product of a bunch of incremental steps taken by many folks in and out of government. Sometimes government funds were involved and sometimes not. A lot of times not.
    One example. Bill Joy refused to put the DARPA implementation of TCP/IP into BSD Unix and instead re-wrote it. If you’re curious, not that there’s any evidence of that, you should check the number of hosts connected to the Internet after that occurred. Bill joy was an employee of Sun Microsystems at the time.
    If the government had merely conceived the idea of the Internet full-fledged, as you seem to imagine, and set out to build it we’d have some kludgey national BBS that could only be accessed with hardware purchased at the post office. Fine, but let’s stipulate that government occasionally does some fine things like winning World War II or declaring national holidays. The point is more often we are treated to ghastly dreck such as described in the OP. The record is not a winning one particularly when government ventures so far from its core expertise of, well, I’m sure it has one.
    Next the dispute at hand is that government is considering taking steps to effectively deny a certain medicine to sick people. You claim it doesn’t make any difference because that medicine doesn’t extend the life of those sick people. Your own citations however show that the medicine does delay the onset of symptoms. Therefore patients taking it suffer less and have more time with their families. Which proves the point of the OP. This is exactly the sort of thing people that oppose Obamacare feared when the legislation passed. It seems likely we will see more of this rather than less.
    Meantime, you waste a lot of time with side issues like calling people names, or obsessing weirdly over Sarah Palin or touting up the Internet as an example of governmental awesomeness.
    Now you’re onto spending per capita as if this was your argument all along. Admit it, you dropped in hoping to start a squabble in the comments (and managed to get a rise out of one or two posters) but you don’t really have any original thoughts or ideas about the topic at hand. As you are basically oh-fer on this thread why not quit (I await your clever S. Palin reference at the suggestion, you clever chap) while you’re behind? You may be about to spring some argument I’ve never heard and considered but the contingency is a remote one.

  52. Ragspierre says:

    “The problem with the US health system is we pay way too much – 40% or more than any other country in the world without a commensurate return on hour total health care.”
    And the cost is all because of BIG GOVERNMENT distortions in the market…oh, and that fact that your sentence is fundamentally a lie.
    But, you ain’t seen nothin’…
    As ObamaCare kicks in, costs will skyrocket, and “return on hour (sic) total health care” will go in the toilet…along with individual freedom and the general economy.
    They are allowing IDIOTS into Switzerland, Germany, Iceland, France, Iran…
    Move where you can be in your element. Leave America to be exceptional.

  53. Ragspierre says:

    http://hindenblog1.blogspot.com/2010/08/crash-deemocrat-election-strategyrun.html
    Rats…sinking ship…
    Leave, puke. ObamaCare WILL be the most violated law since Prohibition. Until it’s repealed…

  54. nishner says:

    “It is the product of a bunch of incremental steps taken by many folks in and out of government.”
    Well yeah, that’s pretty much the way with everything – people build on the work of those that have gone before. And lots of inventions are serendipitous, rather than planned. But thanks for at least admitting Big Government had a hand in it. And DARPA did set out to build the infrastructure for a network to connect research institutions that served as the basis for today’s Internet.
    Big Government emplyee Vannever Bush’s vision of a ‘Memex’ certainly maps back closely to today’s web. Ted Nelson’s hypertext also was an important influence. Don’t think he ever worked for the gov though.
    Again, assuming you’re keeping up, the argument was that Big Government can never do anything right. That’s laughably wrong and simply a myth of deluded Tea Baggers. Without Big Government, modern society would collapse. You put talented people in, you get good results. You put in ideologues that want to destroy government, they usually succeed.
    Avastin costs close to $100,000 a year.
    ****************
    “And the cost is all because of BIG GOVERNMENT distortions in the market…oh, and that fact that your sentence is fundamentally a lie.”
    Actually, it’s not. Most, maybe all, of those industrialized countries that provide care at a lower per capita cost than the US have much stricter government regulation and involvement in health care than does the US. Google’s your friend. Practice, you might learn something.

  55. Ragspierre says:

    “Again, assuming you’re keeping up, the argument was that Big Government can never do anything right. That’s laughably wrong and simply a myth of deluded Tea Baggers.”
    No, stupid. That would be like saying the Dark Ages NEVER produced any great art. Cripes…!!!
    BIG GOVERNMENT ruins. That is the rule. Of course there are exceptions that prove the rule.
    “Without Big Government, modern society would collapse.”
    Again, an absolutely STUPID statement. Consider, how did we get to the early Twentieth Century?
    How did Hong Kong become a center of wealth?
    We need SOME…very limited…central government. The genius of the Constitution, which of course you deplore.
    And, F-Your stupid-I, read some history. FDR’s wage and price controls BEGAN the practice of employers bidding for good people using perks…like health care. Before that, it was a market transaction. Look into things that ARE NOT the subject of gross government intrusion…like Lasik, plastic surgery, and veterinary care. All the subjects of the market’s genius at innovation, cost reduction, and excellent patient care.
    I really should be providing you some lube…

  56. nishner says:

    “BIG GOVERNMENT ruins. That is the rule. Of course there are exceptions that prove the rule.”
    Tea Bagger Logic at Work:
    BIG GOVERNMENT ruins, except when it doesn’t. Which only proves that it does.
    But hilarious!!!


  57. “The problem with the US health system is we pay way too much – 40% or more than any other country in the world without a commensurate return on our total health care.”
    First, until the U.S. economy went into the tank (and only the intervention of civil government in the market economy can cause such a decompensation by deranging the negative feedback mechanisms which preserve economic viability), the American population enjoyed a massive advantage in discretionary spending when compared against the citizenry of other nations.
    Ceteris paribus, when such spending capacity is available, people tend to elect spending options that had had lower priority when spending power was less available. Americans marked up their preference for spending on their health, a preference change facilitated – or exacerbated? – by distortions imposed upon the health care market sector by politicians grabbing for greater government power.
    Second, the ways in which “commensurate return on … total health care” expenditures are calculated can be (and have been) undertaken so as to create an unfavorable appreciation of the outcomes secured in America, the better to sell the idea of turning the whole of this effort over to the control of the politicians.
    In matters such as infant mortality, for example, one country can look a great deal better than America by simply under-reporting. We consider a neonate salvagable under conditions where medical authorities in other Western countries do not, and we will account a neonatal death preventable (and therefore accruing adversely to our infant mortality rate calculations) when a statistician in a “better” country simply discounts such a one-gasp-and-dead infant as a specimen that never had a chance.
    It’s easy to look good if you make sure that your failures don’t get counted.
    And this is largely what is done in countries with rigid politician control of their health care. The government thugs who hold authority (and therefore responsibility) for decisions made in these polities know full well that to keep their jobs and grow their little bureaucratic empires, they have to conceal the ill effects of their decision-making.
    So this is what they do. What’s that Lincoln line about fooling all of the people some of the time?
    Well, some of the time is enough for most government thugs. The long run doesn’t count for them. One of their favorite facilitators, after all, is quoted as having said (with regard to currency inflation), “In the long run, we are all dead.”

  58. nishner says:

    “Government Thugs.”
    Why do you hate military, the police, the fireman, the postman, the school teacher, and on and on and on?