Cancer Journal

          I’m drawn to health care economics like a moth to a candle flame. The pull this time is the invoice I got along with delivery of my oral medication. The stuff I take as i fight this thing with fists wrapped in tape. A 30 day supply, 120 pills, has an invoice price of $11,791.48. Huh. That would feed a lot of children in Bangladesh.             Now I’m thankful to have them. I should not quibble on price, especially since the co-pay is only $200. Surely a lot of sophisticated biochemistry and dedicated effort from highly capable people went into developing the drug. And then the FDA approval process! Like poor Sisyphus pushing that rock.             The costs for all this would all have been fixed costs. Unless the pills contain some rare earth element or something, the extra cost of each additional 120 pills is surely trivial. So, how do you set a price fo...

        In a prior blog entry, I suggested that there was a limit to the value of the lives of health care consumers in my age cohort. Old horses put out to pasture, I called us. In comments to the blog, someone gently reproved me for discounting the value of love that old horses can give. I realized that this is most certainly true. Grandparents can provide a foundation of loving support that some kids can just need for any semblance of emotional wholeness, especially when Mom has a disordered life that doesn’t include looking after the kids the way they should be looked after.        In my job, holding hearings on why people either got fired or quit their jobs, I heard snippets of life stories. The ones most piercingly painful were when grandmas died. It was taking away something that needed to be there. It was always grandma. If it happened with grandpa, I never heard about it. Not that it couldn’t.       ...

      A note on numbers. In my first blog, I referred to a PSA# of 24. In my entry on the drop in my PSA, I speak of a reduction from 30 to 1.9. What’s up with that?        Let me explain. Just before my initial treatment, they tested my PSA for a baseline. I did not write of that. That number came to 29.9. At the time, the doctor, in speaking of it, rounded it down to 29. Later, when the PSA took a dramatic drop, he rounded it up to 30. I like him better for doing that.        Also, in going online to the Patient Portal and checking my lab report, I find that the drop was down to 1.8, not 1.9 as I think I reported before. Either I misheard or the doctor misspoke. Probably the former. No big deal but just to avoid confusion.        The Patient Portal has a graph of the progression of my PSA numbers. I tried to cut and paste it onto this blog, If that can be done, it requires comp...

(This entry was written while I was in the clinic waiting room before getting the news I report in #5)       It takes some chutzpah to write about health care economics when it’s really not something I know about. Just this one and I think that’s it.   Ezekiel Emanuel wrote an article in the Atlantic about six years ago entitled Why I Hope to Die at 75 . In it, he expressed the intention of receiving no life extending medical treatment after that age. The reasons he gave were strictly personal. It was best to be remembered by family while he still had vitality and mental sharpness, best to pass on the torch of family leadership when his children were relatively young, best for he, himself to go before he experienced significant mental and physical decline. He had some other reasons too. It’s a good article. You should read it if you have the time.        Although he has had a significant role in developing national health ca...

          Good News! I went in for a recheck on my PSA number today. It went down from 29.9 to 1.9 which is a long way from the caution number of 6 or 7. On the low end of normal, I think. Both the doctor and I were very happy.              Who knows why that happened. My treatment of course and then a change in diet.  A lot of vegetables and no red meat.  I have had Vitamin C infusions (a subject for a future blog entry) and then there’s prayer. My semi-regular prayer has been “Wash Me” and I feel a whish or something from the Holy Spirit whenever I do. I mentioned diet and Vitamin C to the doctor but not the prayer.  I go in again next month and will tell him then.             Cancer is a crafty enemy that does not give up easily. He will no doubt try switching to asymmetric warfare of some sort so I best not think this thing is in the bag. Still the ne...

  Cancer Journal #4-a      Health care costs a lot.  The meter rolls at an alarming rate—at least according to the monthly statements I get and the meter will only speed up as the bills for my current treatment rolls in.  Not out of my pocket, of course.  Medicare and my Medicare supplement policy cover all but relatively modest drug co-pays but still, if those statements reflect the value of what’s being done for me, I find it all a little distressing.      I’m retired.  My children are grown.  My life’s work can, in most respects, can be called finished.  I get to enjoy the pasture.  But look at the doctor’s bills and it is high priced pasturage.  I see a misallocation of resources.  More should go to my grandchildren's education and well-being and less to extending the life of the old horse whose plowing days are over.  But then, at least on an individual basis, there’s another way of lo...

         It’s VIP parking at the Mayo Clinic Cancer Center with parking slots a few steps from the door. Speaks more to our presumed physical condition than our importance I suppose but it’s handy, especially if I am running late. The accommodation is not meant for me, at least not right now. In fact, I feel great. I’d never know there was anything wrong with me if they hadn’t told me. Still, the parking is handy.       Inside, people in the waiting room are not doing great. Mostly they are old. A few young ones that I really feel bad for. A woman in her 20s with a slow, unsteady gait and not much light in her eyes. I hope her condition is curable and that this will just be a bad episode in a fully lived life.       I don’t visit with those who are waiting although that would be my natural tendency. We are all masked and social distanced which inhibits conversation. And then, talk loud enough to be heard w...

     Fedex delivers oral medication that, along with a dose of radiation and a timed released injection, constitutes my current treatment regimen. Surprisingly big package for a bottle of pills. It turns out to contain a boxed set of stuff entitled "Fight Gear". There's a photo of a hand being wrapped in fabric strips like preparation for a bout in Fight Club . Gonna do this thing bare fisted!   Inside are product information pamphlets, an application for grants to cover the hefty $200 co-pay and a couple of devices to help in remembering to take the stuff. There are photos of ruggedly handsome older guys with expressions of grim determination.        I'm put off by the manipulation of this packaging. Wrap up the fists to win the battle to remember to take the meds every day? Actually, the pills are surprisingly big and the daily dose is four of them all taken at the same time. Maybe it takes a certain manliness to get these horse...

     PSA-17. Oh. That’s high! Let’s check back in three months. PSA-24.4. We need to do a prostate biopsy this week. The news of the biopsy, delivered over the phone is business-like, maybe two or three degrees less warmth from the doctor than before. I think of wartime telegrams delivered at the front door by uniformed officers. It’s the message, not the messenger, that is important. Still, the manner of how the message is given stays in the memory.        No need to say, “Give it to me straight, Doc.” I get it straight. Prostate cancer is in there with a Gleason Score of 8 which is at the low end of aggressive. I think of Jackie Gleason who really doesn’t have much to do with the situation. They do a bone scan within the week. More bad news. It has metastasized into various parts of my bones. Again the doctor, a different one, gives it to me straight. Once it has metastasized, prostate cancer is incurable. The average life ...