More Pharma Rhetorical Fallacies

After my post about the audacity of Big Pharma showing some rhetorical resistance to comparative effectiveness research, my comments section received a visit from Ken Johnson of PhRMA.  On my post, and on a similar post by Duncan Cross, Mr. Johnson used the experience of PhRMA CEO Billy Tauzin as ballast for the argument that government intervention in health care.  There’s one big logical fallacy in the argument, though.  His champion example of medical miracles through medicine has nothing to do with rationing by government interference and, indeed, showcases the failings of our own health care system much more than the perceived problems in other countries.

Here, as on Duncan Cross’s blog, Mr. Johnson references Mr. Tauzin’s brave and against-the-odds victory over cancer – a victory improbably engendered by the drug Avastin.  It’s a great story, and a counterpoint to the story in today’s GOP Budget about a woman being denied a cancer drug in Great Britain because of its cost.  It’s worth quoting:  “As a result of centralized government restrictions, many cancer patients overseas do not have access to the life-saving cancer treatments that are widely available in this country.  It is a sad fact that a cancer medicine that saved his life is not available to cancer patients in some other countries because their government denied them access to it.”

Except there are three big problems with the Avastin miracle – all of which actually reinforce the argument Duncan and I are making for comparative effectiveness research and a comprehensive overhaul of our health care system.

Number one, the single biggest reason people don’t get Avastin has nothing to do with health care boards in other countries determining that they won’t carry it.  The single biggest reason is that too many people here at home can’t afford it.   Duncan Cross has done a great job deconstructing the myth that Mr. Tauzin's experience with Avastin was in any way typical, and I encourage you to read his whole post. To summarize quickly, Avastin costs $4,000 to $9,000 a month, usually with an additional mark-up.  Last year, the New York Times profiled the sad stories of Avastin users forced into bankruptcy or being denied the medication outright by their insurance.  This is rationing, all right, but it has nothing to do with the government, and it has nothing to do with other countries.  It’s homegrown tragedy.

Number two, Avastin is licensed and able to be prescribed in the UK, but is not widely in use because of concerns about its side effects.  Avastin is approved for use for colo-rectal in Canada since 2005, Germany since 2006, France and Japan since 2007.  I’m having a hard time buying Avastin as the poster-child for why we shouldn’t allow government to increase its research into the effectiveness of treatments.  Now Avastin is not approved and will be denied in these countries for treatment of macular degeneration.  You know who else denies it for use in macular degeneration?  The FDA, in no small part because it wasn’t designed to do that in the first place.  Although many doctors have begun using it off-label for this purpose, a whole lot more research needs to be done before it’s deemed safe and effective.
So I suppose life-saving cancer drugs are being denied to people in other countries by their governments… but only if you count people who don’t have cancer.

Number three, there’s actually tremendous doubt, even within Pharma and the oncology universe, that Avastin is actually worth the expense.  Mr. Tauzin’s results are atypical – most of the time, Avastin lengthens life by four months, and not by a statistically significant margin over other forms of chemotherapy.  In the same NY Times story, Merck’s former CEO Roy Vagelos said point-blank, “There is a shocking disparity between value and price, and it’s not sustainable.”  That doesn’t make me feel a lot better about how good a job we’re doing with pharma now, before reform has even begun.

Mr. Johnson’s right – it is a sad fact that people do not have access to the life-saving pharmaceuticals that saved Mr. Tauzin and thousands of others each year.  But the saddest of these stories occur right here, in the U.S.’s broken health care system.

(Photo credit:  Darren Hester on Flickr.)