Avastin: The Ministry of Health refused saying that although it does increase the life expectancy of colorectal patients it just wasn’t worth the cost.
Ontario to colorectal cancer patients – “die quickly”
Last week Rep. Alan Grayson (D-FL) stated in the House that the Republican Party’s health plan is for sick people to “die quickly”. No doubt Grayson’s stunt arose from all of the publicity that was given to Congressman Joe Wilson after he shouted “you lie” at President Obama while the latter was addressing Congress. Grayson was obviously seeking to rise from obscurity to get the media and the talking heads to pay as much attention to him as they did to Wilson.
If Rep. Grayson thinks that socialized medicine or even more government control over health care is the answer to people dying quickly, he should take a good look at what is happening north of the border, specifically Ontario.
In September 2005, Health Canada approved the use of the drug Avastin. While Avastin does not cure colorectal cancer, it can stop its growth and extend the life of the cancer patient. Eventually the drug fails to work and it is recommended that the patient stop using it at that point. Depending on the required dosage that each patient needs, each treatment costs between $1500 and $2000.
Two months after Avastin was approved for use in Canada, a group of oncologists recommended that Ontario fund the use of the drug. The Ministry of Health refused saying that although it does increase the life expectancy of colorectal patients it just wasn’t worth the cost. In 2007-08, further medical evidence emerged that showed Avastin’s effectiveness in prolonging the life of cancer patients and again medical experts requested that the province provide funding. Other Canadian provinces were already funding Avastin treatments. On July 2, 2008, the province announced that they would fund the drug but only up to 16 cycles. Patients were entitled to 12 treatment cycles plus an additional four if they could show that the drug was still having a positive effect. After the Ministry of Health’s decision to fund it Avastin but with a cap in place, the matter was referred to Ontario ombudsman, Andre Marin.
At the end of last month, Marin issued a scathing report entitled “A Vast Injustice”. Marin’s view on the matter can be seen not only by the title of the report but by some of the headings contained in it; “As Transparent as Mud”, “Getting Past ‘No’” and “Patients Running on Empty”. The ombudsman said that the policy regarding the funding of Avastin “verges on cruelty”.
Marin determined, through gathering evidence from expert oncologists that the mean number of treatment cycles that colorectal cancer patients and prolongs their lives is 17. In other words half of those treated with the drug are benefitting and living longer by having more than 17 treatments. The ombudsman found that placing the cap on Avastin was arbitrary and not based upon sound medical evidence. Limiting the number of cycles that a patient could receive at 16 was done solely for financial reasons.
After Marin’s report was issued, the Ministry of Health refused to lift the cap and disputes the fact that their decision was not based upon medical evidence. David Caplan, the Health Minister (now the former Health Minister; he resigned as a result of a financial scandal; not denying Ontarians medical treatment) did indicate that the province would develop a new “compassionate review policy” regarding patients who are receiving Avastin treatments. In other words the province will make it easier for those who have already received 16 cycles and are still benefiting from the drug to beg for more treatments. And since Ontario prevents its residents from obtaining private health insurance for medically necessary services, those who are refused further Avastin treatments will either have to pay for the drug themselves or do without.
Whether or not what Ontario is doing amounts to “death panels” being in place is really a matter of semantics. The reality is that when healthcare is run or controlled by the government, financial limits are put in place and these limits can be arbitrary as Andre Marin found was the case with Avastin. The medical evidence is clear; people whose lives are being prolonged with the drug are having their lives shortened by the government’s policy.
While Rep. Grayson may think that “dying quickly” is a good political stunt, colorectal cancer patients in Ontario are not likely to see the humour in it.
