Opinion: Death makes health-care debate unique

If you’ve watched much TV, you’ve probably seen the ads from pharmaceutical giant Bristol-Myers Squibb, which is spending more than $100 million annually on the campaign.

“For adults with an advanced lung cancer called squamous non-small-cell,” the announcer says, “… it’s not every day that something this big comes along: A chance to live longer, with Opdivo.” That message — “A Chance To Live Longer” — is driven home in large white letters throughout the ad, which features grateful-looking patients watching a baseball game, playing with a grandchild or otherwise spending time with loved ones.

The ad doesn’t present Opdivo as a cure, because it can’t. In lung cancer cases, it is approved for use only when other treatment regimens have failed. The average patient on Opdivo survives an additional 90 days compared to a patient on standard chemotherapy, and the side effects can be so severe that patients cease treatment altogether.

Now, the human survival instinct is a powerful thing, and for someone with Stage IV lung cancer, those 90 additional days can have a lot of appeal. But if placed into context, and if we have the courage to address it honestly, the Opdivo case also opens the door to a broader, deeper discussion of the health care industry, morality, economics, politics and hard truths about human existence.

For example, the Opdivo ads focus on treatment for lung-cancer patients, although the drug is approved for late-stage melanoma and kidney cancer as well. Nationwide, less than 200,000 cases of non-small-cell lung cancer occur each year. So if Bristol-Myers Squibb is advertising its small-market drug in the same expensive, mass-market fashion that Budweiser advertises beer, you might suspect that its per-unit profit must be pretty high.

You would be correct. In the third quarter alone, Opdivo generated $920 million in revenue for Bristol-Myers Squib. The company generates that revenue by charging patients roughly $140,000 for the initial treatment, with an additional $14,000 for each subsequent month.

I’m a healthy person, and I have no loved one with lung cancer. But with three important caveats, I can sit here and tell you that if I were diagnosed with late-stage lung cancer, I don’t think I would pursue Opdivo treatment. Prolonging the inevitable with a questionable quality of life doesn’t interest me much.

But the caveats? First, that’s a personal decision, not a decision that I impose on others; second, if the patient were a loved one, I might think differently about the value of those extra 90 days; finally, and candidly, until I’m actually faced with that grim diagnosis, my armchair theorizing about what I might do can’t really be trusted.

From there, the questions grow broader and more complicated. Does a lifespan increase of 90 days justify a $200,000 cost when that cost is shifted either to taxpayers or other insurance customers? How many lives could be saved outright if the billions spent on Opdivo were spent instead on, say, smoking cessation or opiate addiction treatment?

In Britain, officials have refused to approve Opdivo for ordinary use on the grounds that it is too expensive and have urged Bristol-Myers to lower its cost. Yes, they are explicitly rationing health care on grounds of cost, but lest we Americans get high and mighty, the current debate in Washington over the fate of Obamacare, Medicare and Medicaid is, at root, also about rationing health care on the grounds of cost.

We just choose not to acknowledge it as such.