Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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Right Angle Club 2017
Dick Palmer died this year. We will miss him.

Suited To A "T"

{Privateers}
Mucous Membrane Pemphigoid

After sixty years as a doctor, it's a little disconcerting to find I have a disease I never heard of. It's better in a way, but in this sense it is worse, to be cured by a treatment I never heard of, either. The disease is mucous membrane pemphigoid, and the cure is Rituxamide. Am I right? Most readers have never heard of either one, but like just about every other patient, I think you all must be panting to hear about it.

{Privateers}
Rituximab

It turns out I had heard about the disease, but it had changed its name from lichen planus to mucous membrane pemphigoid. The drug, Rituxamide, has been around since 1997, treating rheumatoid arthritis, so it's not completely novel, either. When we got these issues straightened out, and I had experienced a second round of treatment, I attended a seminar on lung cancer. That's the sort of thing doctors do for entertainment. To my puzzlement, I was told a "me, too" variant of this drug extended the life of lung cancer patients, but only if they were heavy smokers who quit smoking. That sounded sort of funny, very much like saying you live longer from lung cancer if you smoke heavily and don't quit. So, you get a little euphoric when you take a steroid drug to ease the Rituxamide, so I was overcome with the audacity to go to the microphone and announce I thought they lived longer, not because it helped the lung cancer, but because they had fewer heart attacks and strokes from the smoking they had quit. Of course, I was politely told I didn't know what I was talking about. But an immunologist in the audience rose to say he agreed with me, because he had been giving the drug to practically every patient in his immunology practice, and quite a few of them got better. (To explain, the drug knocks out the T cells, which mediate most autoimmune diseases, so it sounded plausible.) So that's where matters stand. After everybody scrambles to try the drug on various autoimmune patients, some sort of order will probably emerge.)

But before everyone who reads this demands that his doctor give him this drug for itchy skin, let me tell you another story. My insurance company sent me what is known as an "EOB" (explanation of benefits) which had two numbers on it. In the upper left-hand corner, it said my bill was $67,000. In the lower right -hand corner, it said, the amount owed, was $0.00. Somewhere between the two numbers is the amount you would have to pay if you didn't have insurance, the rest is someone's mark-up. So, I set about to find out how much the drug really costs to manufacture, and I don't yet know. Someone said $4, but I can scarcely believe it.

 

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