The amount your treatment has cost is astonishing.
The mind boggles. But I would not be alive without it. Five-and-a-half years ago, I learned I had stage IV metastatic stomach cancer, a life expectancy less than a year. But, here I am, feeling well, no evidence of disease. So I wouldn’t be alive without it. But yet it’s radically overpriced.
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Would your life be worth something different if it weren’t for your health insurance, which covers most of the cost?
There are two questions there. One is how much is a human life worth in terms of your money, the money you’re hoping to pass to your heirs. Second is how much is it worth in terms of somebody else’s money. That’s the fundamental problem of the US system. It’s warped in terms of it being somebody else’s money, which is why the people don’t rise up in rebellion against what the pharmaceutical industry is charging.
For my health insurance, through Michigan State University, I’m only paying about $100 a month. It’s not trivial, but it’s quite a bit better than paying $10,000 a month.
Would you keep going if it were $10,000 from your pocket?
Yes. For me it’s worth that – probably worth $100,000 a year, or even more. But that’s the other thing: how much money you have. I have savings for retirement. Most Americans don’t.
What are you worth? How we calculate the value of a life
Each life is equally valuable. Until it’s not. From the cost of saving your life to your worth once you’re gone, there’s a price on all our heads
As a doctor, you are very aware of unsustainable medical spending in the US. How do you reconcile that with paying so much for your care?
Well, I must say there are times when I wonder whether I’m worth it. My stomach cancer was caused by Helicobacter pylori infection, which could have been diagnosed for about $20. Now for the cost of my therapy, we could have tested and treated for a lot of Helicobacter and prevented a lot of stomach cancer. But I try not to think too much about whether my life is worth it, because that way does lie madness.
When I was first diagnosed, I started trying to come up with mathematical models to choose whether or not to actually get treated. But the fact is, these drugs are not expensive – in Australia and India, they cost at least 30 per cent less.
This is not the The Doctor’s Dilemma by George Bernard Shaw, where there is only enough of a new medication to treat one of two patients, and the doctor must choose which of the two will live and which will die. The ethical issue here is the pricing of drugs, and the fact that our government is supporting it.
This is the main way I get around the question about whether my life is worth it, because in fact, there’s not a shortage. The drug is not inherently expensive.
“The current system is immoral to its core. We need to deal with ethical pricing of pharmaceuticals”
How do you think regulation needs to change?
The current system is immoral to its core and based on false assumptions and false economies. We need to deal with ethical pricing of pharmaceuticals. The only thing that makes any sense whatsoever is to go to a single payer. Then it could really negotiate from a strong position with the pharmaceutical companies, with the hospitals and with the doctors – that’s the only way that we control healthcare costs.
Will you stay on Herceptin indefinitely?
I keep asking my doctor about how long to continue, and I keep looking at the medical literature, but there’s not a very good answer. Herceptin was approved for breast cancer in 1997. It wasn’t approved for stomach cancer until 2010, one month before I was diagnosed. So, there are people who have been on it for breast cancer for well over 10 years, and they only went on it if they had advanced disease.
Would they still be alive if they’d gone off of it? Nobody knows. And of course, the pharmaceutical industry is never going to fund a study like this. My guess is, I probably don’t still need it. But if I were invited to volunteer for a study where I’d be randomised to stay on it or go off it, I wouldn’t do it – because, if nothing else, I have developed a severe psychological dependence on it. Every morning I wake up shocked at how non-dead I am.
How has the way you value your life changed?
I enjoy food more than I used to when I had a stomach – I used to take it for granted. In general, I appreciate things more. So, yes. There are ways in which time is more valuable to me now than it used to be.
I’m married to my second wife, and she has really made life worth living. I have three children and one grandchild, who’s just turned 2. I never would have seen her, been able to hold my wee granddaughter. It’s one of the biggest clichés around, but how do you price on that?
