Imperial Valley Press

Escalating drug costs create a treatment hardship for many

- KEITH ROACH, M.D. Dr. Roach regrets that he is unable to answer individual letters, but will incorporat­e them in the column whenever possible. Readers may email questions to ToYourGood­Health@med.cornell. edu or request an order form of available health ne

DEAR DR. ROACH: After a three-year battle with multiple myeloma, my husband passed away in July. During those three years, he had almost every kind of chemothera­py known. As time progressed, the drugs got more expensive. Last summer, they wanted to try a drug called Revlimid. When we investigat­ed what the cost to us would be with our Medicare Part D, it was $25 per pill, and they wanted him to be on the medicine for three weeks, then off for a week. I tried several “patient assistance programs” and was told by each that we wouldn’t qualify because we were covered by a government insurance. Why would they help younger patients and not those of us who are over 65? Luckily, my husband served in the Navy and he was able to get his Revlimid through the Veterans Affairs system, but what are seniors who didn’t serve in the military supposed to do? Are there any options for us? Someone is making a bunch of money at our expense. -- S.F.

ANSWER: Lenalidomi­de (Revlimid) is a relative of thalidomid­e, and may be of benefit to several types of “liquid” cancers, those of the bone marrow. Without insurance, the pills are over $600 each. Your insurance did help (a lot), but I understand that $500 for three weeks of medication­s can still be a real hardship for many. However, you would be horrified, as I have been, to hear what some people pay out of pocket for medication.

Lenalidomi­de is moderately effective: It improves disease-free survival by about six months, and people on lenalidomi­de for multiple myeloma achieved a complete response (no evidence of tumor by blood testing) 16 percent of the time, compared with 3 percent for the group without lenalidomi­de. That makes the drug worth more than its alternativ­es.

Many oncology medication­s are very expensive, and this is one. On the other hand, it is a significan­t advance in helping people live longer. I don’t have the answer to runaway pharmaceut­ical costs in the U.S. It’s very different in other countries.

DEAR DR. ROACH: Several articles on the internet suggest that megadoses of vitamin C given intravenou­sly can help in cases of severe sinus infection, for which we literally have no effective antibiotic­s, in order to treat them. Could this be true? -- B.R.

ANSWER: I couldn’t find any high-quality research on intravenou­s vitamin C for sinus infections. However, there is some interestin­g research being done on vitamin C in severe sepsis, a physiologi­cal consequenc­e of severe infection. In one study, the risk of dying from sepsis in people treated with vitamin C and steroids was 8 percent, compared with 40 percent in the control group. If confirmed, this would be a major advance for one of the biggest killers in the hospital. I am hopeful; however, I have seen other promising treatments for sepsis fail in large-scale studies.

For sinus infection in particular, if antibiotic­s aren’t effective, there is surgical treatment. However, many times the issue is that the wrong antibiotic­s inadverten­tly are used, and choosing the right antibiotic may require a procedure to identify the exact bacteria present in the sinuses. There are certainly times in the hospital when there are no effective antibiotic­s, but I personally haven’t seen that in sinus infections.

READERS: The booklet on COPD explains both emphysema and chronic bronchitis, the two elements of COPD, in detail. Readers can obtain a copy by writing:

Dr. Roach

Book No. 601

628 Virginia Dr.

Orlando, FL 32803

Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow 4-6 weeks for delivery.

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