Worthless Drugs and Patient Fear

The latest from the War on Cancer is a finding from the FDA that Avastin, a drug that showed some promise in early trials for breast cancer patients, does nothing at all to slow the disease or prevent death. They have revoked permission to sell Avastin as a treatment for breast cancer. It will remain on the market as a treatment for other cancers, though, so doctors can continue to prescribe it "off label" for breast cancer patients. (In the US, once a drug has been approved for any disease or condition, a doctor can prescribe it to treat other conditions, whether it has any effect on them or not.)

Raising the question, will insurance companies to pay for this worthless drug? Medicare has just announced that they will:

“The label change will not affect our coverage,” the spokesman, Don McLeod, said.

Why? It does no good. Why would we encourage doctors to keep prescribing a very expensive medication that has no measurable effect on patient outcomes?

Meanwhile, according to the Times,

some women fear that insurers will no longer pay for the drug, putting the medicine, which costs about $88,000 a year, out of reach for most women.

Why would you "fear" that your insurance company would stop paying for a drug that does no good? Welcome to the crazy world of modern American medicine, a mishmash of science, faith, hope, and nonsense, sustained by trillions of dollars that flood through the system without anyone bothering to even check if the money we are spending does any good or not. Or even causes harm; one finding of the FDA study was that in combination with some other drugs Avastin can lead to much higher rates of life-threatening complications like internal bleeding.

The Avastin case has gotten a lot of attention from right-wing commentators, including the Wall Street Journal, who think the revoking of Avastin's approval by the FDA represents the cutting edge of the rationing we will see under Obamacare. This is all hot air, though; the FDA commission does not consider the cost of medications, only their effectiveness.

Orac, skeptical blogger and physician who specializes in treating breast cancer, has an extended discussion of the technical issues involved. His bottom line is that no study has shown that Avastin extends the life of breast cancer patients by even one day, and he is highly skeptical of claims that it improves quality of life. He supplies this quotation as a sort of summation:

"The FDA should never have approved Avastin for breast cancer to begin with," said Fran Visco of the National Breast Cancer Coalition. "We don't see evidence of benefit, but we do see evidence of harm."