Medical Economics (and Politics)

G et ready! The landscape in medicine is probably going to change rapidly. The starting bell rang in December 2010 in Washington, DC, with very little fanfare when the Food and Drug Administration (FDA) banned doctors from prescribing Avastin to patients with advanced-stage breast cancer. 1 Avastin, a potent but costly drug, has worked in some clinical trials by halting the spread of cancer and giving women another treatment option. The chief side effects include bleeding and hypertension, which appear to be manageable. The FDA stated that there was not " sufficient " benefit to balance Avastin's risk. Interestingly, they didn't claim that it didn't work, just that it wasn't good enough. I wonder how many women with end-stage breast cancer, or their families for that matter, would agree? It appears that the FDA made an economic decision—not a medical one. If Avastin were cheap, it probably would have been approved. Unfortunately, it is not; therefore, patients and their families were denied a treatment option. It certainly looks like a rationing decision. The FDA and other government agencies appear to be looking past safety and efficacy to cost-benefit ratios. It's reasonable to examine these ratios, but it appears that this process has been taken out of the hands of patients and their physicians. We may see this type of cost-benefit decision making even more frequently now that Congress has shifted its responsibility for many medical issues to the Independent Payment Advisory Board (IPAB). 2 This unelected 15-member group, appointed by the President and approved by the Senate, has responsibility for controlling costs, starting with Medicare. Medicare spending will be capped starting in 2015. The cap level of spending will be determined by inflation in the general economy and in health care. In 2018, the upper limit will be set by the Gross Domestic Product Growth Index. Since this system will soon be implemented, it is timely and important to take a look at the politics involved. Realize that if Congress approves this board's cost-controlling recommendations and the President signs them, they go into effect. If Congress does not want to deal with a sensitive or difficult issue and chooses not to vote on it, it stills go into effect. Worst of all, if Congress disagrees with the board's recommendation but the President supports it and Congress cannot generate a two-thirds majority to override it, then the recommendation still goes into …