Friday, August 29, 2008

The Cost of Profit: Blindness

About four years ago, I had a sudden onslaught of Wet Macular Degeneration -- there was a week delay in getting to a specialist in El Paso --- by that time central vision in my right eye (my best eye) had already been compromised. Wet Macular Degeneration is when rogue blood vessels enter the macula of the retina and begin to bleed, thereby ruining the sensitive surface of the macular that enables central vision. Using the best medical approaches available then -- my retinal specialist, Dr. Metrikin, was able to slow down, but not completely stop the destruction of my central vision. Finally, when Avastin, an off-label medication, was available he gave me a series of three injections of it. Avastin designed by Genentech and used successfully for colon cancer -- was not intended for Wet AMD (age related macular degeneration). However, the community of retinal specialist throughout America had discovered it was extremely effective when injected into the eye to stop the bleeding in the macula. After three treatments, the bleeding was stopped, but by that time I had lost my central vision. With my left eye closed I can't watch TV, read, use the computer or drive.

SouthWest Retinal Consultants were the only group in El Paso and the three physicians took care of everyone. Their crowded waiting rooms were filled with many Hispanics of meagre income, but the practice did not turn anyone away. They would arrange something.

When Genentech saw the success their Avastin product was having with this eye disease -- they altered it -- primarily, making the molecules smaller and called it -- Lucentis. They thought this slight alteration would it more effective. They knew it would be more profitable. Since it would technically be a "new" drug -- they could charge much more claiming it was a solution to a delicate situation.

The catch is that they want $2000 per injection. The Avastin approach is $ 60. per treatment.
When Lucentis came available, my doctor's group continued using Avastin because they believed it was every bit effective as Lucentis -- and switching to Lucentis, frankly, would mean blindness for those without insurance and the independent funds to pay, i.e. the bulk of their practice.

What follows are some excerpts from an Associated Press article that appeared in today's local paper:

By KEVIN FREKING | Associated Press Writer
3:50 PM CDT, August 27, 2008

What does a company do when there's anecdotal evidence that two of its drugs are equally effective in treating a leading cause of blindness in the elderly, one costing patients $60 per treatment and the other $2,000?

In the case of Genentech Inc., nothing

The company declined to seek federal approval for the cheaper drug, Avastin, to treat the wet form of age-related macular degeneration. Nor would it help finance — or cooperate with — a National Eye Institute study comparing the effectiveness and safety of Avastin, a cancer drug, and the more expensive eye drug, Lucentis.

The financial stakes stemming from the study are huge. Medicare officials estimate there could be 50,000 or more additional cases of macular degeneration a year. Treating just one year's worth of new patients with Lucentis would cost $1.2 billion a year, compared with $60 million if they're treated with Avastin, Medicare officials said.

Many eye doctors believe Avastin works just as well in treating macular degeneration even though it hasn't been approved for that purpose. It's not unusual for drugs to be used off-label — treating diseases other than ones the drug was approved for.

Dr. Philip Rosenfeld, who has treated hundreds of his eye patients in South Florida with Avastin, said Genentech had little economic incentive to help finance the trial — unless it was confident Lucentis was truly superior.

"By fact that they didn't support the clinical study leads me to conclude that in reality there is no difference between the two drugs," Rosenfeld said. "The result is clearly not in Genentech's best interest."

I will end with this quote from a blogger on a site called "Fact-esque" ----

All those of you who believe the high cost of medicine in the US is some sort of force of nature that can't be resisted, listen and learn: it has been deliberately engineered to be high-profit expensive by drug companies and for-profit HMO's who promised their investors - and themselves - $$$millions$$$. This is how they deliver on that promise. There's nothing mysterious or otherworldly about it.

It's called "GREED".