“Profits Before Patients”: National Drug Shortages Are Threatening Cancer Patients’ Lives
Millions of Americans battling cancer are facing obstacles to recovery that have nothing to do with the disease’s toll on their bodies. According to a new study, national shortages of cancer drugs are threatening the health of the people who rely on them to stay alive.
According to the survey, presented at an oncology conference in Chicago on Monday, about 83 percent of cancer specialists have experienced a drug shortage at their clinics in the past six months. Of those doctors, 92 percent said the shortage had some effect on their patients’ care.
A little over a third of the doctors facing a shortage ended up switching their patients from a cheaper, generic version of that drug to a more expensive brand-name version. Considering the fact that cancer care is already exorbitantly expensive — Americans battling cancer are twice as likely to wind up bankrupt compared to those who don’t have the disease — that could represent a serious strain on those patients.
But cancer patients are facing much more than potential financial hardship. Thanks to the shortages, some cancer specialists can’t find the drugs their patients need at any price. When that happens, doctors are forced to make some painful choices. Nearly 80 percent reported that they switched patients to a different, and potentially less effective, chemotherapy regimen. Some have been forced to give cancers more time to spread further by delaying patients’ treatment or reducing their doses. And 37 percent of the study’s participants even had to choose between their patients, deciding which ones could receive life-saving medication and which ones would have to go without.
William Li, the executive director of a foundation that sponsors research into blood vessel growth, told USA Today that some hospitals are forced to hold lotteries to decide which patients will be able to receive the cancer drugs that are in short supply. “It baffles the mind that this is happening in a modern society,” Li said, pointing out that the FDA should do more to avert drug shortages.
Currently, drug manufacturers can alert the FDA when they suspect an impending shortage, and the federal agency can take steps to try to mitigate the effect on the market, like approving the same kind of drug from a different manufacturer. But so far, that hasn’t been enough to avert the situation. Largely due to manufacturing errors in drug-production facilities across the country, the U.S. faces limited supplies of everything from ADHD medications to painkillers — and cancer patients end up being hit the hardest.
Much of the blame may lie with powerful pharmaceutical companies. One of the co-authors of the new study, Keerthi Gogineni, noted that cancer doctors are concerned drug manufacturers may be prioritizing the most profitable medications over the most life-saving ones. “Some manufacturers have diverted existing production capacity from less profitable agents to more expensive agents,” Gogineni explained. Similarly, a group of over 100 doctors recently criticized Big Pharma for “causing harm to patients” by continuing to sell cancer drugs at unsustainably high prices.
By: Tara Culp-Ressler, Think Progress, June 3, 2013
“A Lesson In Civics”: If A Budget Cut Doesn’t Impact The Wealthy, Congress Won’t Fix It
As thousands of air travelers suffered through flight delays last week, the average American got a lesson in civics: when you cut government spending, it has real life consequences. Americans are fond of saying that they want to slash government spending in the abstract, but loath to point to specific programs that they actually want to cut. With sequestration, this ambivalence has come home to roost. Because the automatic spending cuts known as sequestration affect all programs evenly, the ones that touch middle-class Americans, not just the poor, have suffered equally.
We haven’t just learned a lesson about the effects of budget cutting, though. We’ve also been able to see the priorities of Congress in stark relief. The flight delays, a result of furloughs at the Federal Aviation Administration, were not the first effects of sequestration. Those were visited on the poor. Yet the FAA was the only agency that saw swift and bipartisan action. After Congress was flooded with calls from angry travelers—not to mention, as lawmakers started down flight delays for their own flights home for recess—the Senate and House each passed a bill with overwhelming support within forty-eight hours. When’s the last time you remember that happening for any other issue?
The poor have long known that a budget cut passed in Congress means hardship in real life. This dynamic was in full force as sequestration went into effect. The first to be hit by the reduction in funds, by and large, were low-income Americans. Preschoolers have been kicked out of Head Start. Food pantries have closed. Native American health services have been reduced. Thousands of cancer patients on Medicare have been turned away from clinics. Meals on Wheels is delivering to fewer elderly people. The long-term unemployed will receive severely reduced benefit checks.
While these cuts have been well covered by local media, the rest of us haven’t heard much about them. Yet when furloughs delayed flights, they dominated the media, as did the cancellation of White House tours. In mainstream cable news coverage, flights were mentioned about two and a half times more than Head Start, over twice as much as cancer patients, and six and a half times more than Meals on Wheels. White House tours were even worse: they were mentioned thirty-three times as often as the sequester’s impact on the poor.
The coverage of tours and flights was likely driven by something we don’t see very often: budget cuts that impact nearly all Americans. Targeted cuts tend to focus on programs that the poor rely on, and we rarely hear those stories. But even middle-class and well-to-do Americans were feeling what it’s like to have reduced government spending in their daily lives when they went to the airport and waited an extra hour to take off. This is surely a mere inconvenience compared to losing food or housing if you’re poor, but it’s still important: Americans of all income levels may finally be learning the importance of government spending in their lives.
As Suzanne Mettler has demonstrated, many Americans do in fact benefit from government services. But few realize it. Mettler calls this the “submerged state”: the variety of public programs that are delivered in such a way, such as through the tax code, that many don’t realize they’re getting assistance. The epitome of this contradiction is the senior who shouts, “Get your government hands off my Medicare!”
For this reason, perhaps, well-off Americans tend to be less concerned with spending on the social safety net and more interested in cutting government spending. This has huge consequences for our political system. A body of research has shown that the needs and desires of the poor rarely influence how their representatives vote. On the other hand, Congress’s priorities nearly duplicate those of the wealthy.
And here is the last lesson sequestration has taught us: just how much more Congress cares about what’s bothering upper-middle-class citizens than what’s going on at the bottom of the income scale. There are tons of different programs expecting a big impact from sequestration. None of them saw multiple bills introduced in the Senate, one of which was passed with huge support on both sides of the aisle and signed within a matter of days. Had they continued, the furloughs would have been more than an inconvenience. They could have meant sharply reduced economic output. But the same could be said of many of the cuts to other programs. The lesson is not that the flight delays should have gone unaddressed. It’s that if a budget cut doesn’t impact a wealthy constituency, Congress can’t to be bothered to fix it.
By: Bryce Covert, The Nation, April 28, 2013
“Eyes Wide Shut”: GOP Representatives Now Realize Effects Of The Sequester They Voted For
Representative Renee Ellmers (R-NC) introduced a bill on Tuesday that returns sequester-cut funding to physicians to provide chemotherapy drugs to patients. The Cancer Patient Protection Act of 2013, H.R. 1416, restores sequester cuts made to Medicare Part B in order to provide cancer treatment and reimburse physicians for the costs of cuts already made.
Ellmers, who voted in favor of the Budget Control Act of 2011, called these cuts to cancer treatment “unintended consequences.” However, the cutback in funding wasn’t accidental, as Ellmers suggests—the Budget Control Act explicitly orders a sweeping two-percent cut to Medicare.
Despite her efforts to reverse its inevitable effects, Ellmers still defends the sequester. “I do believe it will start a very important process that will help our economy to start to grow,” she said. “The debt that we have at the federal level is our biggest threat for our country.”
Representative Blake Farenthold (R-TX) joins Rep. Ellmers in opposing elements of sequestration despite having voted for it. Farenthold, among others, was disturbed to hear of the closing of 149 air traffic control towers—especially those in Texas. The congressman sent a letter to FAA Deputy Administrator Michael Huerta, stating, “I am deeply troubled for your public statements and proposed actions regarding the effect of the sequester on smaller, local airports. These airports have long played a vital role in economies across the country.”
Congressman Rodney Frelinghuysen (R-NJ) was among the 269 representatives who voted in favor of the Budget Control Act, yet he too did not hesitate to criticize its effects. In Frelinghuysen’s district, children in Washington Township may be unable to enroll in Head Start programs due to lack of funding. Frelinghuysen said, “I view potential budget cuts to such an important program as another reason why sequestration is a bad idea.”
To date, sequestration has had significant effects on many Americans, and is expected to cause upward of $85 billion in cuts to communities across the country. The elderly have lost vital programs like Meals on Wheels; veterans may face difficulty accessing mental health, substance abuse, and job counseling services; and funding can be cut for medical research of illnesses like Alzheimer’s Disease.
The effects of sequestration are tangible; millions across the country have faced cuts across a range of industries. Rather than criticizing the effects of the sequester and introducing legislation to obtain certain exemptions from these imminent cuts, perhaps members of Congress like Ellmers, Farenthold and Frelinghuysen should have weighed the consequences before even voting for the measure.
By: Allison Brito, The National Memo, April 11, 2013
“The GOP Trickle Down Effect”: Sequestration Takes A Toll On Cancer And Medicare Patients
A funny thing happened on Rush Limbaugh’s radio show yesterday. The Republican host was complaining about a Washington Post report on sequestration cuts hurting cancer patients in the Medicare program, and told his listeners to ignore the news. “All of this is manufactured and made up,” Limbaugh said. How does he know? Because the sequester didn’t include “any cuts in Medicare,” he added.
And then Limbaugh got a call from a conservative oncologist — in this case, a physician who apparently shares the host’s worldview and has no use for the Washington Post — who conceded that the report is, in fact, accurate, forcing Limbaugh to change the subject.
Sequestration cuts are affecting Medicare — though not as much as some other programs — and as Sarah Kliff explained, cancer clinics really are turning away thousands of patients as a result of the Republican spending cuts.
Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially.
Patients at these clinics would need to seek treatment elsewhere, such as at hospitals that might not have the capacity to accommodate them.
Kliff talked to one Long Island oncologist who said he and his staff held an emergency meeting earlier this week and decided they would no longer see one-third of their 16,000 Medicare patients. “It’s a choice between seeing these patients and staying in business,” Jeff Vacirca, chief executive of North Shore Hematology Oncology Associates said.
But if Medicare was supposed to be shielded from the sequestration policy, how is this happening? It has to do with how medical offices are reimbursed for medications that need to be administered by a physician — such as those given to cancer patients.
The New York Daily News reported today:
The so-called sequester cuts will force three-quarters of the thousands of cancer clinics nationwide to start referring Medicare patients to hospitals, according to the American Society of Clinical Oncology and other cancer treatment groups, which have appealed to the White House and Congress for help.
Elderly cancer patients are being hit hard because their drugs are among the handful of pharmaceuticals that were affected by the sequester cuts.
Medicare reimbursed oncologists for the cost of chemo drugs, plus 6%. But under the sequester, the federal government is now providing only 4% on top of the drugs’ cost, which can run $900 to $15,000 for a full course, depending on the cancer.
That 2% difference may not sound like much, but given the costs involved, it’s an enormous pay cut for the cancer clinics, which some are now saying is a prohibitive new expense they can’t afford.
Ted Okon, director of the Community Oncology Alliance, told Kliff, “If you get cut on the service side, you can either absorb it or make do with fewer nurses. This is a drug that we’re purchasing. The costs don’t change and you can’t do without it. There isn’t really wiggle room.”
Note, this doesn’t mean the sequester is necessarily cutting off cancer patients, but rather, it means these patients are being told by their local oncology clinics that they’ll have to seek care at hospitals — where the care will be less efficient and more expensive.
In case anyone’s forgotten, it’s within Congress’ power to simply turn the sequester off. The whole thing could take five minutes. But for now, congressional Republicans have ruled out the possibility of turning it off, and have also ruled out the possibility of a compromise to replace these brutal spending cuts.
With each passing day, we learn of increasingly drastic consequences associated with the policy.
By: Steve Benen, The Maddow Blog, April 5, 2013
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