The March 25th New York Times carried an article titled “Approval for Drug That Treats Melanoma” which reported the benchmark FDA approval of a new drug that benefits patients with almost-always fatal skin cancer. Click the photo below to be taken to the article. 

(photo from www.nytimes.com)

The novel infusion drug, YERVOY™ (ipilimumub, Bristol-Myers-Squibb), “is really the first time in the melanoma field that there is a drug that extended survival in a meaningful way,” as stated in the article by Dr. Gerald P. Linette, an Assistant Professor of Medicine at Washington University in St. Louis, who participated in the clinical trials.

In the prospective randomized studies that led to FDA approval, patients with metastatic melanoma lived about 10 months as compared with 6.4 months for those patients in the control group that received standard therapy.

Recently, the United Network for Organ Sharing (UNOS) issued a report seeking feedback on their new proposed allocation system for kidneys–a complete overhaul of the current system – which seeks to match kidney recipients with deceased donor organs based on age and health.  Click here for report.  It has been evident for a while that the system for allocating kidneys faces many problems—there is an ever-growing wait list with over 100,000 people currently on the list and significantly less donors than are needed.  The looming question, then, is how do we allocate life-saving limited resources?    

The question of allocating scarce resources is often posed as a “priority problem” with several opposing options: (1) giving the scarce resource to the worst off, (2) using an utilitarian argument by focusing on the greatest overall good, or (3) using a first-come, first-served method.  Each of these options presents their own unique benefits and downfalls.  The current system tends to allocate based on first-come, first serve with compatability (but there are numerous stories over the years that note the ineffectivness or blatant violation of this).  The proposed system, however, adopts a more utilitarian argument, focusing on giving priority to those first with longest estimated survivial and then to a recipient within 15 years of the donor organ if the donor organ has a KDPI score of greater than or equal to twenty percent.  The overall goal of the proposed system is to increase the total life span following transplant.

At first glance, one might wonder if the article in today’s New York Times by Deborah Sontag—“Immigrant’s Health Crisis Leaves Her Family on Sideline”—is signaling a paradigm shift in health care delivery that may be just as dramatic and earth-shattering as the Karen Ann Quinlan, Nancy Beth Cruzan, Terri Schiavo, or Sun Hudson cases. Click the picture below to be taken to the article.

(photo from www.nytimes.com)

The patient—a 58-year-old legal immigrant from Rwanda in a persistent vegetative state after a devastating stroke eight months ago—lies in Georgetown University Medical Center maintained by a surgically placed feeding tube. Because of her immigration status she is not eligible for Medicaid.

On February 19, her court-appointed guardian agreed to the removal of the artificial feedings and the institution of a palliative care plan over the objections of her six adult children (two of whom are United States citizens).