Health and Government

There were two articles in today’s The Wall Street Journal that drew my eye.  In the first article, Joseph Rago interviewed John Lechleiter, CEO and Chairman of Eli Lilly & Co.

Mr Lechleiter offered these comments, among others:

In 1960 the average life expectancy in East Asia was 39…. In 1990, 30 years later, it was 67. Think about that. Does that explain the Asian economic boom? I think it might go a long way….  Wealth follows health, and it ain’t the other way around.

Lechleiter expanded on the point: longer, healthier, more productive lives, and more of them; more workers; an expanding middle class; more opportunities for the formation of capital—this virtuous medical-economic cycle is helping to generate the equally staggering growth in China and elsewhere in the region.

This could very well be a biomedical century, in the same way that the last was a physical and engineering century, with similarly explosive improvements in capability for taking care of our bodies and minds, and lives.  After a period of labor-saving device advances, now perhaps, a period of advances in  life- and quality of life-saving devices and techniques.

But maybe not in the United States.  Genentech’s Avastin is a drug that had been approved for use as a treatment option for women with metastatic breast cancer; that approval has been withdrawn by the FDA.  The rationale for the withdrawal is instructive:

The National Comprehensive Cancer Network, a highly respected consortium of U.S. oncology programs, has four times reaffirmed its recommendation that Avastin is “an appropriate therapeutic option.”

Perhaps the most telling passage in Dr. Hamburg’s apologia arrives when she rejects such practical expertise because the Cancer Network tries “to provide clinicians with ready access to synthesized information they can use in making patient decisions.” She says the FDA’s judgment is superior because its experts “have extensive qualifications in clinical trial design and evaluation.” Rarely are assertions of regulatory purism over the evidence and practice of the real world so chillingly blunt.

Further, Dr Margaret Hamburg, FDA Commissioner, while acknowledging that many women experience dramatic improvements with Avastin, insists that “it is not possible to determine if there is some subset of patients within the population as a whole that may have had a meaningful benefit.”

I suppose, though, there is a bright side to this.  It isn’t every nation in the world that has such august personages in their governments who personally know better than empirical evidence what the correct course must be.

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