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)

"I got to live a long time to be worth that!" he said. Yet the average patient in the best medical test so far lived less than nine more months.

Federal safety regulators do not regulate the price of end-of-life treatments. They evaluate only if drugs or devices work, not how well they work for their prices.

Medicare, which insures about 80 percent of dying Americans, makes no acknowledged evaluation of cost in deciding what to cover. It is not allowed to negotiate for lower drug prices. Its coverage umbrella sets a standard for private insurers.

Under such pressures, the $1.9 trillion spent on U.S. health care in 2004 will balloon to $4 trillion by 2015, federal forecasters project. In that year, health spending, which claimed 16 percent of the economy in 2004, would consume 20 percent and cost the average American $12,400.

Some believe the country can afford to spend even more _ and that it's worth it. Others fear a crash, with insurance perhaps turning into a luxury item. Nearly everyone, though, agrees there's an upper limit somewhere on the horizon.

"So far, we've given everything to everybody," says economist Lester Thurow of the Massachusetts Institute of Technology. "We haven't made the tough choices yet."

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Yet choices are being made every day, case by case.

Some insurers refuse to cover a treatment. Doctors send patients home to die, sometimes out of mercy. Some patients say enough is enough.

Dr. David Johnson, at Nashville's Vanderbilt-Ingram Cancer Center in Tennessee, pitched Erbitux to his brother-in-law, a 57-year-old married truck driver with advanced colon cancer. However, the drug has barely been proven to extend average survival at all.

The doctor remembers his brother-in-law refusing and saying: "Are you stupid? I'm not giving up my limited resources."

The drug's marketer, Bristol-Myers Squibb, did not reply to repeated requests for comment.