Costly Drugs Force Life-Death Decisions

Bottles of pills line the counter of Rebecca Dague's kitchen in Medina, Ohio, in this May 17, 2006 file photo. Dague takes an array of supplements in addition to the expensive drug, Erbitux, to treat her colon cancer. (AP Photo/Mark Duncan, File) (Mark Duncan - AP)

_ Cancer drugs manufactured in living cells, instead of beakers. These biotech drugs target just diseased tissue, unlike chemotherapy. Thanks to these drugs, some late-stage colon and blood cancers are no longer hopeless.

_ Implants that help the heart pump blood. These devices _ the most common is the left-ventricular assist _ are heir to decades of research in artificial heart technology. They provide an option for some patients with failing hearts.

Some of these therapies, like the biotech drug Gleevec for leukemia or implanted defibrillators for some heart problems, work wonders in many patients. The trouble with many treatments, though, is that average patients gain only several more months of life, studies have found. A lucky few may survive for years, so many seek treatment in the hope of beating the odds.

"Very few people, when told of a potential life-saving intervention, will not be willing to listen. So the question is now: not whether it will help or not, but who pays?" says Dr. A. Mark Fendrick, at the University of Michigan.

Whoever pays, costs are up. This care costs several times more than the older treatments it supplements or replaces. A last-resort cancer drug can cost up to $50,000 a year _ if patients survive that long _ with insurance typically picking up at least two-thirds. A mechanical heart pump can cost more than $200,000, with hospital care.

Reports of these breakthroughs, which often fail to mention the price, may have intensified the distinctly American tendency to view death almost as a personal choice, suggest doctors and ethicists.

"I have two small children, and dying right now is not an option," colon cancer patient Rebecca Dague, of Medina, Ohio, said recently.

Faced with such a disease, more than a third of Americans now would want "everything possible" done to save their lives, up from just over a fifth in 1990, according to a poll by the Pew Research Center for the People and the Press.

For many on the brink of death, the choice of desperate measures is hardly a choice at all. "It's better to pay the money than sleeping with the worms," said Jake Rogers, 62, of Chicago, of his implanted left-ventricular assist device. His doctors implanted a second one in June, when his first wore out after 15 months.

From their first day of medical school, doctors are trained to do their utmost for patients like Rogers. "I think probably there's more tolerance for high cost at the end of life, when all the options have been exhausted," says cost analyst Milton Weinstein, at the Harvard School of Public Health. "I think there's a moral force that causes us to want to do anything we can, irrespective of the cost."

While doctors advocate for the interest of dying patients, they may also be subtly swayed by earning their livings partly from providing this care. And many patients don't fret, because they are insulated from huge payouts by insurance.

Robert Graham, 73, of East Brandywine, Pa., chuckled when he heard the high price _ up to $250,000 _ of heart pumps like the one implanted in him last November. It was covered by insurance.