What should someone dying of cancer do when the last-ditch drug that they have relied upon is shown not to work?
And what do insurance companies and government programs do about coverage when bad news arrives showing that the expensive life preserver to which many are clinging does no good -- and may actually accelerate a more miserable death?
These are precisely the horrible dilemmas that many women dying of end-stage breast cancer face with the Food and Drug Administration’s finding that the drug Avastin does not work.
In 2008, the FDA allowed Avastin to be marketed as a treatment for incurable breast cancer. The approval came under a "compassionate access" program that allows very sick patients access to drugs before all the data that drug companies need to gather to show proof of efficacy has been collected. All the data on Avastin is now in. It does not show any real benefit to women in this desperate situation.
Still, many women with no other option will want to give Avastin a try. And they may be right in that the failure of a drug to show any benefit to a big number of women does not mean that no individual woman might benefit a tiny bit. Still, the picture painted by the data is bleak, the drug costs about ten thousand dollars a month, and it is most likely just to make you sicker as you die.
Those now on Avastin should be allowed by their insurers to make the choice to stay on. The cost is large but it would be wrong to deny the drug to those who want to keep taking it even if the most likely result is that these women will provide the final sample of evidence that Avastin is a failure. But, for new patients not on the drug, the only fair option is to let them have access but not to pay for Avastin with government or private insurance money.
The hope that Avastin might extend the lives of those dying from breast cancer is gone. Those who still want to rely on the drug as they die should not be denied that last choice -- as poor as that choice may be.
But there is no ethical argument in favor of paying for a very expensive drug that does not work for new patients, even when there is nothing else to offer.