Treat the patient as a whole or just the disease.

[calcrew14]

You are a mighty oncologist. One of your post bone marrow transplant patient is essentially on drugs that suppress his immune system. He needs to be on a medication that prevent yeast infection of upper gastrointestinal tract , for an indefinite period of time. It is unfortunate that he is allergic to all medicine but the one that cost about $2400 a month. He has no private insurance coverage and not eligible for public assistant, not until after he has spent all of his assets. Would you make it mandatory that this patiant to take that medicine, otherwise discharge against medical advice, or would you continue to take care of him without that medication?

I am beginning to understand the "treating the disease" that some says allos do it.

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[Gleevec]

You are a mighty oncologist. One of your post bone marrow transplant patient is essentially on drugs that suppress his immune system. He needs to be on a medication that prevent yeast infection of upper gastrointestinal tract , for an indefinite period of time. It is unfortunate that he is allergic to all medicine but the one that cost about $2400 a month. He has no private insurance coverage and not eligible for public assistant, not until after he has spent all of his assets. Would you make it mandatory that this patiant to take that medicine, otherwise discharge against medical advice, or would you continue to take care of him without that medication?

I am beginning to understand the "treating the disease" that some says allos do it.

Id tell him that "in general drugs are cheaper in Canada and that you can buy them on your own, though it is considered illegal" then administer it if he brings it in unsealed/untampered with.

This is assuming there is no feasible way for some other entity to pay for it.

 

[thewebthsp]

Or buy even cheaper generics from India...

 

[viking]

anytime a company can separate two markets it is to their financial benefit to price discriminate. to charge US people the same price as canadians will merge the markets and the price in canada will rise and the price in the us will drop. also there will be less incentive for drug co's to produce and their will be less drugs to help your parents dying from cancer.

 

[Gleevec]

anytime a company can separate two markets it is to their financial benefit to price discriminate. to charge US people the same price as canadians will merge the markets and the price in canada will rise and the price in the us will drop. also there will be less incentive for drug co's to produce and their will be less drugs to help your parents dying from cancer.

I dont think the guy who cant afford immunosuppressants cares too much about the macroeconomics of pharmaceuticals.

 

[viking]

no, he doesn't. he's dying and scared as **** and will do anything to live, assuming he is a secular humanist

 

[calcrew14]

Nice shots so far but.....
The same drug is available at a near by pharmacy for $1,700 a months. The same drug, if available from Canada, is going to be tough to get it for less than $1,500-1,600 a month. I doubt if it is available anywhere else.

The patient has ten other drugs that he is taking. The particular oncologist, not the future one, kindly allows the patient to order those medications from abroad, She knows that the patient has already ordered 9 other drungs from all around the word, about half of those drugs cost him from $50 to $300 a months, each. Let's round it up, the total cost without that mother of them all in the question is several thousand dollars a month extra.

We are talking about something that breaks a camel's back. The patient says that he has been in a marathon race. Only a few hundred yards to go, He would rather drop out than go back to the start line to stay there or restart again. If you know what he means.

 

[Gleevec]

Is there REALLY a medication that expensive that prevents a yeast infection in the upper GI?

You think you could just check him on occassion to see if he starts to develop an infection and treat it, or alter his diet or something.

Then again, I dont know jack squat about yeast infections of the upper GI or drugs used to treat them.

 

[viking]

talk about QALYs and how hard it will be for us, b/c the tech will be there, but the money won't be for everyone;we'll choose who lives and who dies, where before you could do everything in your power to save someone and it was considered noble; now your considered an dingus if you sepend a lot to save someone bc that's money that could have been used to save someone esle. when you start talking socialized medicine, **** gets ****ed up and depressing. we will have hard issues to face as doctors. i say give all you can for each individual even if it hurts others. when you love man more in general you start to hate man as an individual.


as far as this guy. make sure he has people around him who care. make sure he dies without pain. but he's gonna die if he can't afford the drugs. everyman dies , not everyman trully lives.. everyone can't be saved, and if they are; it's only for a while

 

[calcrew14]

Thanks, Gleevec. The medicine is not for prevention of yeast infection of the upper GI. It is for prevention of pneumonia complication that commonly complicates immunodefficient patient. Pneumocystes carinii, I think. Hey, how do you guys know that this is true story? Forget it... Only answer my original question, please.

The name of the medication is Neprom or close to that. A yellow thick liquid.
Okay, the patient can't take Pentamidine and Bactrim.

I should have mentioned that it is now 13 months after the transplant. The bone marrow is free of leukemic cell and cromosome study is normal. The patient is doing fine. The oncologist says that a currrence will be treated with transfusion of donor's leukocytes. It can easily be done. The donor's leukocytes attacks leukemic cells like graft versus host reaction. If you know what the oncologist means.

 

[calcrew14]

The name of the drug is Mepron (Atovaquone.) It is available online from somewhere at about $900 a month.

The question in the original post arises at this time when the patient is doing well a year after the transplant but is fed up with the expenses for both essential and preferably expensive new drugs, even at discounted prices and some opportunity to sustitute with cheap generics. He wishes he does not have to hear of any new drug name at all. At the same time, the oncologist is also up to the neck with the requests to change those brand new and brand name drugs everytime they are precribed.

 

[DannGee]

anytime a company can separate two markets it is to their financial benefit to price discriminate. to charge US people the same price as canadians will merge the markets and the price in canada will rise and the price in the us will drop. also there will be less incentive for drug co's to produce and their will be less drugs to help your parents dying from cancer.

no offense, but this is kind of ridiculous. the pharmaceutical industry is, by far, the most profitable industry in the US, with FOUR TIMES as much return on revenues as the median fortune 500 industry. still, they use far more of their revenue to make themselves and their shareholders richer than they use for R&D. i think much of this is because the powerful lobbying powers the industry has over our legislators. there has to be a more level playing field, balancing the need for pharm companies to be reasonably successful while helping to insulate those in cases such as that described above from having to make such a decision.

 

[nascentdoc]

no offense, but this is kind of ridiculous. the pharmaceutical industry is, by far, the most profitable industry in the US, with FOUR TIMES as much return on revenues as the median fortune 500 industry. still, they use far more of their revenue to make themselves and their shareholders richer than they use for R&D. i think much of this is because the powerful lobbying powers the industry has over our legislators. there has to be a more level playing field, balancing the need for pharm companies to be reasonably successful while helping to insulate those in cases such as that described above from having to make such a decision.

I agree with you. The Pharm. industry is greedy and manipulative, but let's not forget the insurance and oil industries. I think that latter is the most blood sucking bar none. I think last week an oil company out of Texas (I belive one of the largest) pulled something like a 200% profit. Talking about powerful lobies that infiltrate and corrupt very high up. Sorry, don't mean to hijack