September 24, 2010
PAUL RAEBURN, host:
From NPR, this is SCIENCE FRIDAY. I'm Paul Raeburn.
Researchers finished sequencing the human genome in 2003. And even before that, they were linking particular genes to different diseases, finding all kinds of mutations that could lead to breast cancer and other ailments. All of which led people to think: If doctors knew more about patients' genes, they might be able to tell which illnesses each patient would get and how well his or her body would respond to certain treatments....
There's a problem, as my next guest writes in the current issue of The Hastings Report. What if your DNA says you will not get as much benefit from a $100,000 cancer drug as your neighbor, that your neighbor would live two years with the drug but you'd live only two months? Does that mean your neighbor gets the drug and you don't?
Joining me know to explore these kinds of tricky ethical issues is Leonard Fleck, professor of philosophy and medical ethics at Michigan State University in East Lansing. He joins us from a studio on campus. Welcome to SCIENCE FRIDAY, Dr. Fleck....
RAEBURN: When we do this kind of arithmetic and mathematics, do we want to factor in one sees all sorts of numbers about the cost or the value of a human life. Is there any sort of generally accepted figure for that, and do we need that in order to make these decisions?
Dr. FLECK: We need some kind of reference point. And at least healthcare researchers nowadays, they look to the amount of money we spend to save the life of somebody who has who's in kidney failure, and the reason why they choose that particular number is because way back in 1972, when renal dialysis first came online, we had literally thousands of individuals each year who were dying of kidney failure whose life could be saved if they could afford access to dialysis, and most people could not afford access to dialysis because at the time, if you translate those dollars into 2010 dollars, it would have it was costing about $90,000 a year.
And so we passed this program, the End-Stage Renal Disease Amendment to the Medicare program that said we'll pay for dialysis and everything else related to your failed kidneys. We'll do that as a society because we don't want people to die if we have the medical capacity to save them for an indefinite period of time - 10 years, 15 years, 20 years is what is available to these individuals if their kidneys fail early on early enough in life.
And so today the price of saving a year of life per person like that is about $67,000. And so that gives us a kind of reference point. We believe thats a good buy. And so relative to that standard we can say that other healthcare interventions for heart disease, cancer, COPD or whatever that come in at that figure below should be judged to be reasonable buy by our society.
RAEBURN: Now, did was that decision made in the '70s because people hadn't realized what they were getting into? You know, to do an open-ended thing like that would never happen now, I wouldn't think.
Dr. FLECK: That's absolutely correct. No one everyone believed that the renal dialysis technology was a unique kind of technology, and it was because of that uniqueness that we believed it was affordable. They also believed that at 20 years out, the cost of that investment would be about a half billion dollars per year, but the actual cost this year of sustaining the lives of about 450,000 dialysis patients is about 28 or 29 billion dollars. So they clearly underestimated that.
(Soundbite of laughter)
RAEBURN: By a bit.
Dr. FLECK: Yeah, by a bit. Yes.
RAEBURN: Now, in your in the kind of framework that youre developing and exploring here, do you have an opinion on that? Was that a good idea? Was it a - should we stop it? What do we do with that? I mean, I understand politically its tough to stop it, but theoretically, what would be the right thing to do in your view?
Dr. FLECK: In I mean in my view, given the basic wealth of our society, we certainly should continue to provide to continue to save and sustain the lives of individuals on dialysis, though, I have to add, that part of the problem there is that we have gradually expanded the range of individuals who are seen as worthy candidates for dialysis - that is, medically worthy candidates.
And so initially part of the reason why the program was so favorably viewed by Congress was that it was individuals in the middle of life, in their 40s and 50s, who were in kidney failure. And so theres a lot of life left for them to be saved. But nowadays the fastest growing segment of the dialysis population are patients in their upper 70s and 80s. And its not as obvious there that were getting as much good or as much quality of life for those individuals as was true when the program was first funded....
[Hear or read the rest of the interview at
http://www.npr.org/templates/story/story.php?storyId=130104047]
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