Rugs, are as available in the EU as in the US. Noteworthy is that both in the EU and the US these two phenomena (an aging population and expanding life-prolonging medical technologies) interact synergistically to make the cost problem even more irresolvable. That is, greater numbers of individuals are living longer with a greater burden of chronic illness for which more and more can be done to prolong the trajectory that results in death. Marked success (nothing curative) in treating many forms of heart disease has made possible a rising incidence of LY317615 chemical information cancer among the elderly as well as a rising incidence of Alzheimer`s disease (along with many other chronic degenerative disorders). One policy analyst summarized this situation accurately by saying that we are doing better and feeling worse [24]. What would make us feel worse by the often trumpeted successes associated with the development and dissemination of these targeted, personalized cancer treatments? The short answer is that in the vast majority of cases these drugs yield very marginal benefits at a very high cost [25]. For many of these 100,000 drugs median gains in survival are measurable in weeks or months [26?8]. Fojo and Grady, for example, call attention to cetuximab in connection with non-small cell lung cancer [29]. The median gain there is six weeks for 100,000. In cost-effectiveness terms, that means we are willing to spend 800,000 to gain an extra year of life [29]. Economists would point out that this could hardly be a reasonable or prudent use of social resources, especially if numerous other life-years could be purchased at a tiny fraction of that cost by allocating those dollars to meet other life-prolonging health care needs. The cost of saving a life-year for an HIV-positive patient with a four-drug combination would be about 30,000. Why would an economically rational society not make these more reasonable re-allocations of health care resources? Several brief answers might be given to this last question. First, these targeted cancer therapies are being given to patients faced with what will likely be a terminal outcome. They have no other options that are likely to be effective in prolonging their lives. These therapies are regarded as last chance therapies to which greater social value is attached than other kinds of economic goods [30,31]. Second, it is sometimes vocalized and more often silently affirmed that in our society human life is priceless. The intent behind this affirmation is that it is unseemly to make an explicit social decision to deny someone a life-prolonging therapy merely because it cost too much money [32]. The reader will note that explicit is italicized because in the US (to what should be our great shame) we are quite tolerant of less visible implicit ways of denying individuals access to expensive life-prolonging care. We ration by ability to pay. If individuals lack the financial resources to pay for such care, then we respect their autonomous choice to deny themselves such care. Then it is their choice, not a social choice that isJ. Pers. Med. 2013,imposed upon them by legislative or administrative fiat. Third, cancer is greatly feared as a disease. One in three Americans will receive a diagnosis of cancer sometime in the course of their life. That creates substantial social and GW9662 web psychological pressure to make certain that cancer research and cancer therapies are well funded, even if that funding does not represent the most prudent us.Rugs, are as available in the EU as in the US. Noteworthy is that both in the EU and the US these two phenomena (an aging population and expanding life-prolonging medical technologies) interact synergistically to make the cost problem even more irresolvable. That is, greater numbers of individuals are living longer with a greater burden of chronic illness for which more and more can be done to prolong the trajectory that results in death. Marked success (nothing curative) in treating many forms of heart disease has made possible a rising incidence of cancer among the elderly as well as a rising incidence of Alzheimer`s disease (along with many other chronic degenerative disorders). One policy analyst summarized this situation accurately by saying that we are doing better and feeling worse [24]. What would make us feel worse by the often trumpeted successes associated with the development and dissemination of these targeted, personalized cancer treatments? The short answer is that in the vast majority of cases these drugs yield very marginal benefits at a very high cost [25]. For many of these 100,000 drugs median gains in survival are measurable in weeks or months [26?8]. Fojo and Grady, for example, call attention to cetuximab in connection with non-small cell lung cancer [29]. The median gain there is six weeks for 100,000. In cost-effectiveness terms, that means we are willing to spend 800,000 to gain an extra year of life [29]. Economists would point out that this could hardly be a reasonable or prudent use of social resources, especially if numerous other life-years could be purchased at a tiny fraction of that cost by allocating those dollars to meet other life-prolonging health care needs. The cost of saving a life-year for an HIV-positive patient with a four-drug combination would be about 30,000. Why would an economically rational society not make these more reasonable re-allocations of health care resources? Several brief answers might be given to this last question. First, these targeted cancer therapies are being given to patients faced with what will likely be a terminal outcome. They have no other options that are likely to be effective in prolonging their lives. These therapies are regarded as last chance therapies to which greater social value is attached than other kinds of economic goods [30,31]. Second, it is sometimes vocalized and more often silently affirmed that in our society human life is priceless. The intent behind this affirmation is that it is unseemly to make an explicit social decision to deny someone a life-prolonging therapy merely because it cost too much money [32]. The reader will note that explicit is italicized because in the US (to what should be our great shame) we are quite tolerant of less visible implicit ways of denying individuals access to expensive life-prolonging care. We ration by ability to pay. If individuals lack the financial resources to pay for such care, then we respect their autonomous choice to deny themselves such care. Then it is their choice, not a social choice that isJ. Pers. Med. 2013,imposed upon them by legislative or administrative fiat. Third, cancer is greatly feared as a disease. One in three Americans will receive a diagnosis of cancer sometime in the course of their life. That creates substantial social and psychological pressure to make certain that cancer research and cancer therapies are well funded, even if that funding does not represent the most prudent us.