Long overdue

My new(ish) job has eaten up my life. I can't actually remember much about the last six and a half months, which I find disturbing. It seems to be a traumatic-coping mechanism. It's unfortunate, though, that I haven't been writing throughout the experience. Its challenges though probably not worth the "growth" that it's provided are still going to be rich and long-lasting material for understanding healthcare in the U.S.

I am (somewhat bafflingly) working in the pharma/biotech consulting field. I am helping pharma to better market products for metastatic oncology. Except that I don't really believe in their mission nor do I believe in our methods for collecting and analyzing market research. I don't know if I believe in "market research," at least not in its purely market-driven form. It's been frustrating both finding our research methods mechanized and rote and at the same time being highly skeptical of the purpose and goals attached to what we do. Kind of contradictory -- I suppose.

Last summer, I read Atul Gawande's article in The New Yorker, and I cried. It's resonated deeply with me, and I'm posting it here to share. I was reminded of it by this thoughtful post on Arthur Kleinman on Somatosphere, a great collaborative blog on anthropology + science. One of my great frustrations with my work is that we ask doctors whether they would use a product that has a small improvement in survival for patients who are going to die. They are going to die soon. Pharma Company X comes in and asks whether if you could give your patients Product X with these benefits for a few more months, would you do it? Even in our "probes" to explore whether the very unpleasant side effects or the outrageous costs would be prohibitive, the implication always is, well, how could you not offer your patients two, three, 1.5 more months? Not many American doctors would say, 'huh, no. No, I recognize that [as Gawande suggests] a less invasive death is actually better for my patients and their families.'

At the core of the metastatic cancer market is the denial of death. One product I've been working on is with a small biotech company that has a pretty remarkable drug -- an immunotherapy product for a cancer with limited treatment options. The drug costs nearly $100,000. The company's capacity for production is highly limited, even if everyone could pay the exorbitant fee...and yet....aren't we supposed to celebrate and embrace this product for its novel mechanisms and extension of life? Isn't that for what we are all striving?

Underneath all these products and the highly competitive and strategic pharmaceutical marketplace is really the question of whether putting technology in the service of life-extension for any cost is really worth it. Death is everywhere in this work, and no one talks about it.

1 comment:

Anonymous said...

I read Gawande's article on a plane, perhaps en route to see you. That was a mistake, as it led to poorly concealed sniffling and snotting, right there, on the plane, inches from my seatmate.

Such a clear and powerful articulation of . . . kindness, I guess. Compassion that is not afraid to front death.

It stuck with me when weeks later I presided over Mrs. B's final trip to the vet.