How many readers know the right number?

Editors obviously pay me to pass along medical advice to you. But this week I can’t answer a fundamental health question. So let’s switch roles to see if any reader with the Wisdom of Solomon knows the right number to this dilemma. I’ll publish the results, as it’s vital that a figure be found. After all, it’s going to affect how long you live.

Stephen S. Hall writes a fascinating article in the magazine New York about the escalating cost of cancer drugs. New cancer medication now costs tens of thousands of dollars, but may extend lives of patients only a matter of days.

Dr. Leonard Saltz, a cancer specialist at Sloan-Kettering Cancer Center in New York, is an outspoken advocate for doing something to control escalating costs. For instance, he cites the case of a new drug that costs $300,000 to keep a patient alive an extra 42 days. But he says the cost is actually $600,000 when you add on the cost of doctors, nurses, pharmacists, drugs to counter side-effects and other hospital charges.

Critics invariably restate the unwritten rule that doctors should never consider the cost when treating patients. If they do, they say, they’re rationing care. Saltz counters by saying. “Everyone agrees the costs are unsustainable. But what happens when it becomes unsustainable?”

Cancer has become big business with billions spent on cancer drugs. Yet even cancer specialists say that these expensive therapies have relatively little effect on life outcome. In effect, they cost too much to do so little.

The good news is that some malignancies like testicular cancer, some types of leukemia and lymphoma are cured by these drugs. But for malignancies of the prostate, breast, lung and large bowel, the drugs buy little more time, only weeks or months at the most.

Moreover, the patient has to consider the often severe side effects. In fact, Saltz mentions one drug that causes a skin rash so devastating that patients are often asked not to come to work!

But can you blame the pharmaceutical companies for the high cost of cancer drugs? In a free enterprise system it’s their job to make a big profit for their shareholders. But in the U.S. they’re also bankrupting patients. Studies show that cancer patients are 2.5 times more likely to declare bankruptcy than someone in the general population.

For example, one drug to treat skin cancer costs $39,000 a month. Another drug to keep those alive who are suffering chronic myelogenous leukemia costs $92,000 a year. If you have cystic fibrosis, it’s a staggering $311,000. There’s also a new drug to treat a blood disorder called paroxysmal nocturnal hemoglobinuria that costs $525,000 a year.

It quickly becomes obvious that unless you’re a Rockefeller, society, namely taxpayer money, has to cover these costs. But there’s no way to escape the next problem. Society cannot live for health care alone as there’s only so much money in the kitty jar.

So, in the end, society will have to decide either to pay for these drugs (and many other medical expenses) or eliminate other services. And who wants to do away with police, the fireman, garbage collector or cut the social services that so many rely on?

Dr. Saltz says, “There is a number in people’s minds. If you say to people I have a drug that extends life for one day at a billion dollars, should society pay for it? Most people would say no. But if I say, ‘I have a drug that extends life for three years at a cost of $1.50’, I’m pretty confident everybody would say, of course.”

There is however, a number that Saltz calls a “tipping point” where the majority of people say ‘no’. The cost is simply too high for the benefits received.

So here is my question to readers. What is the acceptable number? Remember, we don’t have Solomon to help us. Maybe common sense can play a part. Or is it even possible to find a mathematical solution? But don’t forget this point. The word ‘unsustainable’ means there has to be a number over which we cannot go. I can hardly wait to hear what you think it is.

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