There was a podcast in the weekly Burrill Report about Personalized Medicine’s many challenges that caught my attention. Bioethicist Leonard Fleck, a professor at the Center for Ethics and Humanities in the Life Sciences at Michigan State University, Personalized Medicine, discussed those challenges with Daniel Levine in a recent interview about his article titled “Smoothing Personalized Medicine’s Ragged Edge.”
One of these challenges is about ethical issues such as where to draw the line on who receives treatment based on how responsive a patient will be to qualify to receive a certain therapy. This is a concern, especially given the costs of cancer drugs that can range from $50,000 to $130,000 for each course of treatment. The difference is that somebody might survive an additional two years with one of those drugs versus somebody who might only survive an additional two months with access to one of those drugs.
There is a lot of gray area. It is not so clearly defined as one would hope. “What we want to know morally and politically speaking is whether individuals with such radical different responses to such a drug have equal just claim to have access to that drug”, said Fleck. These decisions are not going to be decided by Medicare, Medicaid, or any other large or visible government program.
He said that, instead, we are going to see emergence of “accountable care organizations.” These organizations will include a very large number of patients and physicians at hospitals and other health care providers who need to stay within their budget. Therefore, they will need to make decisions about what kinds of healthcare interventions “yield too little good at too high a price.” The likelihood is that those decisions, because they are scattered all over the U.S., are not really going to be politically visible.
According to Fleck, the UK’s National Institute for Clinical Excellence is a model for us because it is largely politically isolated from partisan politics. “We can’t have an institution that is going to be poisoned by whatever the current political rhetoric requires of political decisions,” he concluded.