A recent article in the New York Times sheds light on the practice of rationing treatment due to shortages of key medications.
“In recent years, shortages of all sorts of drugs — anesthetics, painkillers, antibiotics, cancer treatments — have become the new normal in American medicine. The American Society of Health-System Pharmacists currently lists inadequate supplies of more than 150 drugs and therapeutics, for reasons ranging from manufacturing problems to federal safety crackdowns to drugmakers abandoning low-profit products.” (NYT)
As a result of these shortages, doctors are forced to make choices about which patients will get certain medications that are in short supply.
“’It was painful,’ said Dr. Yoram Unguru, an oncologist at the Children’s Hospital at Sinai in Baltimore and a faculty member at the Berman Institute of Bioethics at Johns Hopkins University. ‘We kept coming back to wow, we’ve got that tragic choice: two kids in front of you, you only have enough for one. How do you choose?’” (NYT)
Hospitals and doctors are choosing, although there are no consistent rules that exist throughout the field. Children may be prioritized over adults because of their greater fragility; in clearly discriminatory fashion, so-called obese patients may be given only the dose for an average-weight person.
“Such decisions have real consequences. For some shortages, doctors can soon see the effects of rationing, such as increased pain or nausea when drugs typically used to control symptoms are withheld, or patients who have to undergo invasive surgery to control cancer when anti-tumor medications are delayed.” (NYT)
Different, substitute medications are also used. However, the Times notes: “Studies have associated alternative treatments during drug shortages with higher rates of medication errors, side effects, disease progression and deaths.”
You might say, this is sad, but how is capitalism to blame? First, some shortages are caused because pharmaceutical companies have stopped making a drug because it is not profitable enough. In a more general way, the confluence of other problems that lead to shortages are not being addressed in a systematic way because there is no real systematic approach to healthcare under capitalism in the U.S. If healthcare were centralized, if pharmaceutical companies were owned and controlled by a people’s government, guaranteeing the availability of needed medications would be a top priority. Problems in the supply line would be addressed as quickly as possible, as a matter of national security.
No shortage, rationing by cost
A glaring example of medication rationing can be seen in the case of the new hepatitis C drugs. While there is no shortage of these new, highly effective medications like Harvoni and Sovaldi, many patients with hep C are being denied treatment because the medications are so expensive (around $1,000 a day for a 12 week treatment). Other treatments exist, but have much more severe side effects and are much less effective. The new medicines completely eliminate the virus from the vast majority of people who take them.
Insurance companies are denying treatment for all but those with the most advanced stages of liver disease because treating all the millions of people with hep C will drastically cut into their profit margins.
There are vast numbers of people with hep C in prisons; however, prison medical systems are generally not offering these new medicines because of the cost. A well-known example of this can be seen in the case of political prisoner and revolutionary journalist Mumia Abu-Jamal. In August 2015, his legal team sued for his right to receive appropriate care, including a class action suit on behalf of all Pennsylvania prisoners with hep C.
Bret Grote of the Abolitionist Law Center, one of the lawyers involved in Abu-Jamal’s lawsuit, told Think Progress: Grote said. “These new medications aren’t complicated. People take this pill every day for eight to 12 weeks. The issue is cost. Part of this scandal is the monopoly pricing in the pharmaceutical industry for treatments of diseases that affect poor people and people of color disproportionately.”
Monopoly pricing of some medications, abandoning production of others that are not seen as “profitable enough,” slipshod production standards—the end result is people are sentenced to die because of market-based rationing of medication. The system is guilty and must be overturned!
