Hacker News Reader

Comment by refurb | Hacker News Reader

Of course, it's always easy to be cold and calculating when it's not your life or your love ones at stake.

And sure, I think most people would argue it's not worth spending another $500,000 treating a terminally ill patient with a 0% chance of survival.

But often the chance isn't 0%, it might be 15%. So if it's your loved one who has stage 4 cancer and the doctor says "it's going to cost a lot of money and only a 15% chance we'll cure the cancer", not many people will say "meh... those odds aren't good enough, so lets just put grandpa in a hospice and let him go"

View on HN

15% is clearly too optimistic. It is closer to 0.15% and it is usually not only about chances but that the person is experiencing extreme suffering despite pain killers that any therapy only prolongs this suffering.

What do you mean?

Here is an example: https://www.tecentriq-hcp.com/urothelial-carcinoma/clinical-...

For people with cisplatin (chemo) resistant metastatic (spread through the body) bladder cancer, if you treat with immunotherapy only 6% achieve complete response (cure). The other 94% has a partial response (which means they progressed) or no response at all. So they would likely die of their cancer relatively soon.

Lots of cancer drugs are like that.

Immunotherapy is expensive. Is it worth spending $250,000+ on cancer drugs for a 6% chance of a cure?

Then why bother with immunotherapy at all if it's so expensive. After all it's been available for 130 years if google serves me right, and it still hasn't come down in price besides being not very effective.

It's been available for about a decade at this point.

Why bother? That's a good question. I think the answer is "because 5% will be cured and another 20% will have some response which means they may live another few years."

But the problem is, you won't know who benefits and who doesn't. So do you deny everyone a chance at a 5% cure of 20% chance of a longer life? No, you treat everyone and see what happens.

The UK government put a price of ~25,000GBP per year of life (quality adjusted). So even if people are cured there is value in extending years of life.

Maybe it's closer to 0.15%. So what? We do things with little chance of succes all the time. As I said, I'll take my 0.15% chance of living longer and be very grateful for it. Others might not. I still find it strange that money has a part to play in this at all. How cruel would it be to be denied life-saving treatment just because it's not 100% guaranteed to work.

Because 0.15% is not a life-saving treatment but hoping for a miracle. And when people are immensely suffering they actually prefer to die than prolonging the sufferings.

How could not money pay part in this? If the continued care costs, let's say $10,000/month (not unusual for the US) and you have 1:1000 chance to live that month, it means this month has cost $10 million dollars. Who is going to pay for that? In fact, taking all this money for yourself, the healthcare for other people will need to be reduced which can lead to shortened life expectation for those people.

Money has to play a part in it because the people and companies working to deliver the care need to be paid somehow or they’ll eventually have to stop doing it.

This is a resource allocation problem. People (whether individually or collectively) work to create things of value and direct some percentage of that to medical treatment. If that is wasted in rare cases, that’s unfortunate but we accept some amount of imperfection. If it’s wasted in a lot of cases, many other people will go without needed care who didn’t have to if we allocated that spend more effectively.

A basic issue is simply choosing to have a no cpr order if you have a terminal cancer. It doesn’t mean you won’t get treatment but if your heart stops in this particular situation (metastatic cancer) odds of survival to hospital discharge are routinely quoted as <1%. No cpr doesn’t even mean no intubation or no critical care, it’s more of a “seatbelt” to protect you and your loved ones from suffering if everything goes to hell.

Reply on news.ycombinator.com