Let’s Put Our Health Care Priorities In Proper Order

I didn’t know Cheri very well. She came by to help out in the office where I work. She always had a smile.

Anyone who was around Cheri for very long adored her. She was the picture of youth with bouncing hair and eyes that sparkled when you talked to her.

She was a struggling single mom whose shy 8-year-old looked around from behind her mother when we tried to coax the little girl into talking.

Cheri told me how she was going to learn a new job as soon as she got her strength back. She was recovering from her second battle with Hodgkin’s disease, a cancer of the lymphatic system. This type of cancer most often strikes people in their late teens or early 20s.

The medical profession has had some respectable response in treating the disease, which is named for Thomas Hodgkin. He was credited with isolating its characteristics in 1832, even though the symptoms were recorded as far back as 1666.

Dr. Peter S. Rosenthal of Harvard University and Dr. Harmon J. Eyre of the American Cancer Society in Atlanta, discuss the disease in a 1995 book, Clinical Oncology.

In the initial stages, using a single chemotherapy agent such as Interferon can put Hodgkin’s into remission in 50 to 70 percent of cases. However, this remission frequently lasts only a few months before the cancer occurs again, as it did with Cheri.

Rosenthal and Eyre report that a more successful treatment for a lasting remission is with a combination of chemicals.

M.D. Anderson Cancer Center, the medical branch of the University of Texas, has achieved complete remission in over half the cases in which doctors there used a combination of Interferon and Acutaine, a drug often used to treat severe cases of acne. Both chemicals are well known and frequently used by the medical profession. This dual chemical treatment was being used primarily on the East Coast, but in some limited cases was available elsewhere.

Some insurance companies are refusing to pay for the treatment, because they consider it a clinical trial procedure, even though it has achieved a high success rate and even though they pay for the Interferon treatment for cancer and the Acutaine treatment for acne.

Thus, Cheri’s doctors were forced to treat her with Interferon alone. They knew that with this third occurrence they might slow the spread of cancer but there was little hope of any remission.

The insurance company was practicing medicine, overriding the medical advice of the doctor who recommended the treatment he considered to have the best chance of success.

Should medical professionals be the ones to decide about treatment and should insurance companies cover it, even if the treatment is new and still considered a clinical trial?

Or should an insurance company have the right to decide what treatments will be used by refusing to pay the cost of others?

First, we have to understand what a clinical trial is and why it is important. Advances in medicine and science are the results of new ideas and approaches developed through research. New medicines and treatments are tested in laboratories and proven over and over before they are offered to a human patient in a clinical trial.

In 1923, Sir Frederick Baning and John Macleod won the Nobel prize for isolating insulin. The treatment was a clinical trial then, but it has saved many thousands of lives since. In 1945, a Scotsman, Sir Alexander Fleming, won the Nobel Prize for his work in the discovery of penicillin. When he shared his knowledge of this byproduct of mold, and it was used to treat many soldiers in World War II, it was a clinical trial.

Clinical trial or not, doctors save lives, often when old methods offer little hope. This is why insurance companies should pay for the treatment and leave the decision of how to treat the patient to the medical professionals. Too frequently, the best medical treatment is denied the patient because an insurance provider refuses to cover the cost.

So, Cheri was again fighting cancer. She had beaten it into submission once with chemotherapy and radiation therapy. When it came back again, she was given a bone marrow transplant. Again, the Hodgkin’s disease retreated, giving Cheri and her family a breather before it recurred.

Cheri flew to Texas to be tested to see if she was a candidate for the treatment that had shown so much success. She was accepted and returned to Spokane with high hopes that this time they would beat the cancer for good.

However, it was business as usual with the insurance company and the bottom line ruled its decision. They might call it a clinical trial, but it boils down to one fact: It costs too much. Cheri didn’t beat the cancer this time. It finally beat her, two weeks before her 29th birthday.

Maybe you can’t put a value on human life, but insurance companies do it every day.

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The following fields overflowed: CREDIT = Mark W. Harry Contributing writer