The Times' War Against Health Care?
The deck of headlines to Tuesday's off-lead story by Reed Abelson and Andrew Pollack seemed relatively innocuous: "Medicare Widens Drugs It Accepts For Cancer Care - More Off-Label Uses - Untested Options Are Expected to Raise Health Costs."
Yet the story marked the fourth in an informal series of front-page stories in the Times arguing for limiting people's health care choices in the name of cost savings.
Instead of looking at the use of off-label drugs as a bureaucratic reform, or as a way to help patients whose diseases remain immune to treatment, the paper fretted about "health costs," a philosophy in tune with the Times' editorial push for universal health care and the subsequent rationing that would be required to keep down costs.
The latest story unwittingly pointed out a hazard of universal health care - the rationing of what the federal government decides are "unproven drugs" or drugs the government has decreed are not cost-effective, no matter what a doctor or patient might think.
Medicare, with little public debate, has expanded its coverage of drugs for cancer treatments not approved by the Food and Drug Administration.
Cancer doctors had clamored for the changes, saying that some of these treatments, known as off-label uses, were essential if patients were to receive the most up-to-date care. But for many such uses there is scant clinical evidence that the drugs are effective, despite costing as much as $10,000 a month. Because the drugs may represent a patient's last hope, though, doctors are often willing to try them.
The new Medicare rules are the latest twist in a protracted debate over federal spending on off-label drugs - drugs prescribed for uses other than those for which they have been specifically approved.
Proponents of the changes say such spending not only helps patients, but can also enhance medical understanding of which treatments work against various forms of cancer.
The unlabeled liberal group Consumers Union later made an appearance:
But opponents argue that the new approach may waste money and needlessly expose patients to the side effects of drugs that may not help them. They also raise the possibility of conflicts of interest, because the rules rely on reference guides that in some cases are linked to drug makers.
The new policy, which took effect in November, makes it much easier to get even questionable treatments paid for, critics of the changes say. Medicare is providing "carte blanche in treatment for cancers," said Steven Findlay, a health policy analyst for Consumers Union. He said overly expansive coverage encourages doctors to use patients as guinea pigs for unproved therapies.
Because Medicare officials canceled a cost analysis of the changes, it is hard to predict how much spending will increase beyond the $2.4 billion Medicare paid in 2007 for cancer drugs. But cancer doctors and other experts say the new policies, adopted in the final months of the Bush administration, seem almost certain to raise the federal drug bill, while making it more difficult for the new administration to rein in spending on unproven medical treatments.
Of course, aspirin was an "unproven medical treatment" once. Surely the Times isn't suggesting medical progress be hobbled in the name of cost-cutting? Would Times reporters be as dispassionate and bottom-line oriented about health care if themselves or a member of their family could possibly benefit from the off-label use of a drug?
When the Times did let the pro-drug side make its points, it took care to offer a rebuttal:
Medicare officials defend the new policies, saying they respond to cancer doctors' concerns that the agency has been too slow to recognize promising new off-label treatments. Dr. Steve Phurrough, who has overseen coverage for the agency since 2003, noted that a 1993 federal law gave Medicare specific authorization to cover some unapproved uses of cancer drugs.
"Congress wanted a lesser level of evidence," Dr. Phurrough said. The question of what is adequate evidence is "not a line in the sand," he said. "It's a broad stripe in the sand."
The American Society of Clinical Oncology, which represents cancer doctors, has hailed the new rules, saying they will ensure that the appropriate off-label uses are covered.
But some specialists say that being able to offer off-label drugs can also let physicians avoid hard discussions with patients about a grim prognosis.
