Viewpoints: The Promise And Price Tag Of A New Cancer Drug; Medicaid In Indian Country
A selection of opinions on health care from around the country.
JAMA:
FDA Approval of Tisagenlecleucel: Promise and Complexities of a $475 000 Cancer Drug
Unlike most cancer therapies that are identical from patient to patient, CAR-T therapies are made by removing the T cells of a patient, genetically modifying them to respond to certain targets expressed on the patient’s cancer cells, and then reinfusing the cells. When the T cells come into contact with the relevant target (for instance, CD19 in the case of ALL), they proliferate while secreting a number of programmed substances including inflammatory cytokines that destroy the cancerous cells. Targeted killing of tumor cells by lymphocytes was first suggested by the graft-vs-leukemia effect in bone marrow transplantation, but that effect and the infusion of donor T cells more generally has no effect on solid tumor malignancies or most hematologic cancers. The innovation underlying CAR-T involved exploiting the specificity of antibody-mediated recognition of tumor antigens, and then engineering CAR-T cells to have the relevant antibody fragment fused to the T-cell receptor. Thus, the “living drug” infused into the patient is the patient’s own T cells altered to express a receptor that is specific for the target antigen on the tumor. (Peter B. Bach, Sergio A. Giralt and Leonard B. Saltz, 9/20)
High Country News:
How Will Medicaid Cuts Affect Health Care In Indian Country?
In the legislation introduced by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., on Sept. 12, federal Medicaid and health insurance subsidy dollars would be given as a lump sum to states, which would have wide discretion in how they were spent. Nowhere would this be more devastating than in Indian Country. ... In Medicaid expansion states, from Alaska to Maine, the Affordable Care Act has meant that the Indian Health Service, which provides care to 2.2 million of the nation’s 5.3 million American Indians and Alaska Natives, has been able to provide preventive services. Those include screenings for breast and colon cancer, never before available to non-elderly adult patients. Now IHS can provide those services and get reimbursed by Medicaid, instead of having the cost of the services come out of IHS’s grossly inadequate budget. (Tanya H. Lee, 9/20)
The Charlotte Observer:
Protests At Charlotte Abortion Clinic Go Too Far
Our government has a responsibility to protect people’s First Amendment right to assemble and peacefully protest. It is also incumbent on government to enforce people’s right to make their own decisions about their medical care. At A Preferred Women’s Health Center in east Charlotte, these two fundamental rights are clashing. Anti-choice protesters are harassing and obstructing people who attempt to perform and to gain access to abortions. And the city is giving an unfair boost to the protesters, compromising the health and safety of thousands of women. (Lisa Levenstein, 9/20)
Bloomberg:
Defying Ethics Norms Flies With Trump
Health and Human Services Secretary Tom Price has been taking fancy charter flights when previous secretaries flew commercial. Well, what do you expect? Just think about the incentives in a normal administration and in this one. Normally, the president sets a reasonable example of good ethics practices. Oh, there are sometimes controversies, but normal presidents avoid conflicts of interest, follow the guidelines of ethics officials and other best practices, and generally act as if they care about the appearance, at least, of playing by the rules. This president has basically ignored ethics laws and norms from the beginning. It must be hard to care about saving the government a few dollars when the president is using his office to, for example, advertise his business interests. (Jonathan Bernstein, 9/20)
