10 min reading time

Stayin’ Alive: How much would you pay?

At Exponential Medicine this week we met an extraordinary man who told us about his devastating 2012 brain injury from a cycling accident.

He credits his survival to a positive attitude, friendships, goal-setting, online support, and a team of healthcare professionals, among other factors.

But as he shared his inspirational tale, I couldn’t help but wonder, how much was spent on this man’s recovery?

He was adequately covered by insurance. And while uninsured citizens in most countries are entitled to basic care, few could afford the extensive and uncovered rehabilitation he had.

Which brings us to this week’s discussion.
• What is the “reasonable cost” of keeping a human alive?
• How much would you spend to keep you or a family member alive?
• Do your survival odds matter?
• Does it matter how many months you might add?
• Is the patient’s family the only ones who get to decide?

And will the devices being conceived by members of this group lower the costs so dramatically that more can afford the care he received?

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FREE WEBINAR FOR MEMBERS: Big Changes in Australia for Devices

November 18 http://medgroup.biz/TGA-changes but it will be recorded so sign up if it’s interesting for you.

We’ll cover:
• Australia’s aggressive deregulatory agenda
• The Australian tax incentive (43.5% for R&D expenditure)
• The simple process for regulation of clinical trials in Australia
• TGA’s web based submission process for device approvals

That link again: http://medgroup.biz/TGA-changes

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Discussions This Week

Is the Apple Health Kit a medical device (under EU MDD)?
http://bit.ly/apple-kit-a-day

Counterfeiting in medical devices
http://bit.ly/device-counterfeit

Republicans now control the U.S. House and Senate. What impact, if any, do you expect on the medical device industry?
http://bit.ly/Repblcn-devices

Draft of German law about devices
http://bit.ly/German-devices

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Make it a great week.

Joe Hage
Medical Devices Group Leader

P.S. Exponential Medicine (hashtag #xmed on Twitter) is live-streaming today and tomorrow at http://bit.ly/xmed-live

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Andrew Kyle
Medical Device Expert; BOD, Startups; Cannabis Devices
A physician friend of my wrote me

I recently picked a new primary care doctor.
After two visits and exhaustive Lab tests, she said I was doing fairly well for my age. (I am past Seventy Five).
A little concerned about that comment, I couldn’t resist asking her, ‘Do you think I’ll live to be 80?’
She asked, ‘Do you smoke tobacco, or drink beer, wine or hard liquor?’
‘Oh no,’ I replied. ‘I’m not doing drugs, either!’
Then she asked, ‘Do you eat rib-eye steaks and barbecued ribs?’
‘I said, ‘Not much. My former doctor said that all red meat is very unhealthy!’
‘Do you spend a lot of time in the sun, like playing golf, boating, sailing, hiking, or bicycling?’
‘No, I don’t,’ I said.
She asked, ‘Do you gamble, drive fast cars, or have a lot of sex?’
‘No,’ I said…
She looked at me and said, ‘Then, why do you even give a shit?

When you don’t give a S… medical costs are at an end. I admire the woman who had the courage to end her life earlier this month. I hope we all have the same alternative to living too long in pain and without a mind.

Denise Skidmore
Software Engineer at BioTel Research (Cardiocore & VirtualScopics)
The money has to come from somewhere, if healthcare reaches 100% of GDP we’ll have nothing worth living for (and nothing to eat). Cost decisions have to be made, it’s just a matter of who makes them and what their budget is. The one side of the question is about withholding care from those in need, but the other side is how much do we have a right to take from the healthy citizen that doesn’t need care? There are always trade-offs, there is no free lunch, somebody pays.

Gert Jan Klok
Technical Compliance Officer at Comecer Netherlands
We proclaim in the western world that everybody has the same rights independed of rase, believe, skincolor etc. etc., Healthcare is one of the basic needs, why should we not try to get a system in place where everybody should have access to healthcare facilities. Society created a system that for everything you need as human you have to pay. It should be nice that “care” should be free of charge.
And yes Robert special the ethical part in al decisions made is many times missing.

Robert Harju-Jeanty
Founder at Medical Lead Nordic
I am sorry for your father James, and happy he can get treatment for free, so do we living in the Nordic countries. The problem is the increasing healthcare costs for society. The % of GDP has doubled in the last 50 years, and is now around 10% in the industrialized countries, US even higher. In the imaginary world of K Marx everybody would be equal. Unfortunately, this is not the case, and never will. Where do we draw the line, my country, your country, my wallet, your wallet, my age, your age, my political party, your political party? It is a huge challenge for society to decide upon healthcare costs, and make the right allocations. These decisions cannot be purely political, there must be an ethical, medical and economical body that decides, and that is not elected because of political status. On the other hand, those fortunate people who actually can pay for better health, should be allowed to do that without moral critics.

James Viotto
Director of Engineering and Business Development at PolaAir Airconditioning, Heating and Cooling
I agree Richard. My father is undergoing chemotherapy for lung cancer at the moment. He is seeing some of the leading oncologists in the country at the Olivia Newton John Cancer Centre in Melbourne, Australia. We are so lucky that cost does not need to be yet another burden in an already tough time. I really feel for the folks who have lost loved ones because they couldn’t afford the treatment and to be honest, the thought of not treating someone because they don’t have the funds really doesn’t sit well with me.

Richard Jeffery
Managing Director
I find this interesting because here when my father had prostate cancer we had some of the leading cancer specialists and hospitals provided free of charge. This in Australia is expected, if you have a emergency whether it is a car accident to a heart attack society will and should bear the cost. That is one of the benefits of free health care, it is not perfect but when you need it it is there so the question should be “As a society are we not judged on what we can do for the weakest link” in this case health care.

I have a colleague whose seven year old son has just been diagnosed with Leukemia this week, cost does not come into it. He was diagnosed on Sunday, bone marrow transplant on Monday, a great society carries this burden and it is shared by everyone.

Joe Hage
🔥 Find me at MedicalDevicesGroup.net 🔥
Robert, my personal decision would come after a heartfelt discussion with my wife and young children.

Denise Skidmore
Software Engineer at BioTel Research (Cardiocore & VirtualScopics)
Most people don’t have that kind of money laying around, and can’t come up with it in the 5 extra years they’d gain, so although they’d wish to say yes, the answer would be no. I think those that have that kind of cash would spend it without question. The in-between folk are the ones that could sell the house to raise that kind of cash, in which case surviving spouses, at home kids, etc become a major factor.

Robert Harju-Jeanty
Founder at Medical Lead Nordic
Interesting discussion. I would like to ask another question with a different angle.
Imagine you suffer from heart failure with a prognosis of staying alive for less than one year.
If the insurance or the public healthcare would not pay, would you invest, say 200 000 USD in an artificial heart with the chance of prolonging your life with 5 years? Do not take technical challenges into account. To be for 5 more years for 200 000 USD, or not to be?

Denise Skidmore
Software Engineer at BioTel Research (Cardiocore & VirtualScopics)
If I had to make that decision for others, the starting point would be the budget that had been voted on, then try to plan a formula that accounts not for saving a life, but the amount of time life is extended (on average). The formula has to try to look at the averages and keep us from running out of budget and denying all claims at the end of the year.

We all die eventually, all procedures just buy us time, so let’s not look at the number of lives, but the number of days. If childhood lymphoma treatment is successful 20% of the time, and those kids go on to live another 60 years, then on average that treatment buys 12 years. If respirators and intubation of end of life patients on average works 100% of the time and keeps them alive for 2 more years, that treatment on average buys 2 years. So we should consider spending more on the kids even though it “saves fewer lives” than the respirators. Of course, there are costs to consider, which may make respirator years cheaper than post-cancer follow-up years.

But we can’t use days extended alone for all care. Palliative care comes in some very economical forms and shouldn’t be completely rejected just because it doesn’t extend life. It extends the time a person can enjoy life and have meaningful relationships with family. Setting a broken bone probably won’t extend your life, but it significantly improves the quality of life. How would one measure the relative worth of a person’s days? That gets just as sticky as deciding life/death.

If you consider a person’s output as part of the equation, you may as well go back to a non-mandated system. High contributors are usually well compensated or well loved, and can either afford to buy into a well covered risk pool or collect donations for their care.

Diane Demet Tangun
VP Market Development, MBA / International Marketing, Business Development, Commercialization in MedTech, Neuroradiology
This question makes me think of the film “saving private Ryan”… and later the famous George Orwell book “1984”…

This is a deeply disturbing question because a much as it sounds like a practical financial question, it actually brings up the philosophical question of “what is the worth of human life”… and “does the answer vary depending on who the person is”…

If the social system pays, one could argue that age and productivity of the individual would need to go into the equation… Your answer will definitely change if the elderly person that needs “saving” is your beloved mother or not! I won’t even go into the case of the cancer research expert that is “onto something” versus the criminal pedophile…
This is an impossible to resolve debate. I feel I am not apt and I am disturbed by the implications…

Thanks Joe for the thought provoking idea!

Gert Jan Klok
Technical Compliance Officer at Comecer Netherlands
What great discussion hearing so many points of view. That makes me realize the complexity of the world wide health care and the difficult decisions health care people world wide has to make. Thanks

Joe Hage
🔥 Find me at MedicalDevicesGroup.net 🔥
How generous, James, thank you.

Worth repeating from your comment: “…and then there’s the crucial one: do they actually want help. I have too often seen a sick, tired person taking treatment only because the family and friends insist on it.”

James Viotto
Director of Engineering and Business Development at PolaAir Airconditioning, Heating and Cooling
I just joined this group a few days ago as I am currently seeking to enter into the Medical Devices industry. What an introduction! Fantastic, thought provoking post. Thank you Joe!
There are so many excellent responses by so many experienced professionals and honestly, all of them touch on fantastic points. The whole point of the industry is to bring some sort of health benefit to the lives of those suffering in some way and the questions posed by Joe, whilst being confronting are entirely valid. In my humble opinion, it’s almost impossible to quantify the dollar value to be placed on the life of a person. How much is too much to spend on saving or improving the quality of a life? Well it really kind of depends doesn’t it? The emotional me says that the sky’s the limit – especially for my wife, kids, parents etc. The logical, scientific engineer in me says that it is a complex algorithm based on a few factors such as age, general health, health history and then there’s the crucial one: do they actually want help. I have too often seen a sick, tired person taking treatment only because the family and friends insist on it.

Joe Hage
🔥 Find me at MedicalDevicesGroup.net 🔥
Ramona, wow. Were they denied treatment?

Denise Skidmore
Software Engineer at BioTel Research (Cardiocore & VirtualScopics)
Research/experimental care is the antithesis of “standard of care” which is all that insurance/government will pay for.

Slawek Mielewczyk
Biotech Research Project Leader in Diagnostic Devices | Process Improvement Specialist
Challenging question Joe! We should ask those questions to come to the conclusion of the best solutions instead of just waiting for others to make decisions and then complain about them.
I like very much the comment of Warren to look at yourself and your family and think how much would you spent to save your sick child or your sick parent or yourself. That is a great way to start the analysis.
Equally important issue was brought by Gabe that the rate of occurrence of a catastrophic or near-catastrophic event varies greatly between different age groups and sharing the cost and calculated probability makes an obvious sense.
The quality of restored life or improved health needs to be taken account as well as several people wrote.
I can see one more argument for spending a lot of money and effort to save lives and try to rehabilitate and improve lives of very sick people. It is the value of research and finding new ways to solve health problems. We all know that conducting research is very costly, but the knowledge is invaluable and will last for dozens of years or longer and will allow new theories and approaches to be found. New, improved instruments will be made and new techniques will be found that will make future health care cheaper and more effective.

Joe Camaratta
General Manager at MedAvante-ProPhase
Wow! Not what I expected to be thinking about today 🙂

I agree with Warren’s answer: I would think about it differently for myself than for my family members (spouse and children). For myself, I would not want to delay the inevitable and risk my family’s financial future for an extra couple of months. The only exception is a major life event such as child’s college graduation, wedding or birth of a grandchild (and only if was important to my child that I be there “at all costs”).

For my spouse and children, as long as there is a snowball’s chance in hell that prolonging their life could afford them time for a cure, its to “bankruptcy and beyond.” (so long as they are not suffering).

Goldy Singh
VP Regulatory & Clinical Affairs at Profound Medical
These questions are interesting Joe!
However, once someone is hit by an injury or disease, it’s no longer a question of “want”, it becomes “need” to do the best humanly possible to save a life.
The concern I have is: Health Management vs. Disease Management. The burden of disease management is growing exponentially. I would like to see more efforts made for health management services, which I believe will take load off of disease management services.

Denise Skidmore
Software Engineer at BioTel Research (Cardiocore & VirtualScopics)
There is some sharing across borders in the form of charity. Right now there are several groups here raising money to fight Ebola elsewhere. The charity often is very limited in resources and has to take a greatest good for the greatest number approach, handling more simple cases and fewer complex ones. There are a few charities that focus on particular illnesses that can afford to spend more per patient by limiting the population they try to care for.