Months ago I referenced an article about a vaccine for prostate cancer that would cost $90,000 a patient to extend life a few months. It described how the CEO of the manufacturer acknowledged that the majority of the possible recipients would be Medicare patients but he didn’t foresee major problems with getting reimbursement.

A few days ago I attended a presentation from a company representative on the newest iteration of an artificial heart valve developed to replace a narrowed aortic valve, but that could be introduced nonsurgically using a needle puncture technique. The valve is intended for people who are too ill, meaning burdened with enough co-morbidity to be unable to tolerate surgery. They are still trying to define the optimal candidates, but as a group they tend to be very elderly, and one example also had cirrhosis of the liver and advanced kidney disease. The valve kit (not the total cost of the procedure) runs $35,000 and the valve prosthesis cannot be moved if deployed incorrectly; they are hoping future refinements will remove this limitation.

I’ve spent months outlining the current status of the health care system and never cease to be amazed that segments of the medical delivery economy continue to operate as if the past is the present is the future. I believe this behavior, which seems irrational to me, is a form of denial. And perhaps it is just as well, since research and innovation might grind to a screeching halt if reality intervened. Then again, there may still be enough wealthy people out there willing and able to pay for expensive, limited-efficacy interventions in the twilight of their lives to make these innovations profitable. If not, these companies are operating in a fog of hope. Or perhaps I’m the one in a fog, seeing the world through puce-colored glasses, or whatever the diametric opposite of “rose” is.

You decide. I’m going to get some sleep. It’s cheap and studies show we don’t get enough of it.


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