A Medical Case Becomes Political

[question everything]

(I wondered about that myself, of whether Edwards was using the tragic case of Nataline Sarkisyan too much)

The Wall Street Journal

A Medical Case Becomes Political
By VANESSA FUHRMANS and LAURA MECKLER
January 7, 2008; Page A1

John Edwards has been bashing big health insurers in recent days with the story of a girl who died waiting for a liver transplant. But the details of the case suggest the Democratic presidential candidate may be oversimplifying the tale. Nataline Sarkisyan had been battling leukemia for three years. Insurer Cigna Corp. rejected coverage for a liver transplant, then reversed its decision and said it would pay. The 17-year-old died before the operation could take place.

(snip)

In New Hampshire yesterday, the candidate's wife, Elizabeth Edwards, put her arm around the girl's mother, Hilda, before Mrs. Sarkisyan spoke at a campaign rally. Cigna defended its handling of the case. "I'm perplexed that this has become a campaign issue," said Jeffrey Kang, Cigna's chief medical officer. "It is highly unlikely that any health-care insurance system, nationally or internationally, would have covered this procedure."

(snip)

Nataline's case could provide fuel to both sides of the argument about whether insurance companies generally do a good job covering Americans. The day before Thanksgiving, she received a bone-marrow transplant from her brother. Soon after, her liver failed, and she went into a coma. Her doctors at the medical center of the University of California, Los Angeles, recommended a liver transplant, saying that patients in such situations would have a 65% chance of living another six months. Cigna said both its own medical experts as well as an outside transplant surgeon and a cancer doctor with transplant expertise concluded there wasn't enough evidence that the procedure would be safe or effective. But after the denial got press coverage, the company reversed the decision on Dec. 20 "out of empathy for the family." Nataline died later the same day. A UCLA spokeswoman declined to comment yesterday on Nataline's treatment, saying her family hasn't given the university permission to discuss the case.

(snip)

Richard Freeman, a professor of surgery at Tufts University School of Medicine who wasn't involved in the case, said such cases happen too rarely to provide statistically validated medical evidence about the benefit, if any, of a transplant. Rather, it "boils down to a philosophical argument," he said. Some doctors want to pursue aggressive treatment of a patient who appears to be dying, believing it's worth improving the chances, however slim, and fostering medical innovation. Others say the trauma and pain of an invasive procedure such as a transplant are likely to outweigh any medical benefit and the financial costs. John Ford, an associate professor at UCLA who wasn't involved in Nataline's case, questioned in a recent post on his blog whether the survival data for a transplant were clear-cut. "It seems highly unlikely that such data, if it exists at all, has any degree of reliability," he wrote.

(snip)


URL for this article:
http://online.wsj.com/article/SB119967240787671395.html (subscription)

[itsrobert]

1. The word is "PERSONAL" not political

And what's up with posting Rupert's Wall Street Journal. They no longer have credibility.

[seriousstan]

4. I don't care if the newspaper has credibility....do the doctors?

[itsrobert]

8. Without knowing these particular doctors

And what type of Financial Portfolio they have, I can't say.

[question everything]

11. Just because you doubt the credibility

Of a major newspaper does not make your comments valid or credible.

[berni_mccoy]

2. Regardless of the likeliness of any outcome of a procedure, it is NOT the insurance company's place

To make that decision. It's the doctor's.

[itsrobert]

3. HERE! HERE!

That's it in a Rupert nut shell.

[Egnever]

6. You beat me to it

If they werent so concerned with thier profit they would have at least tried. So what if it didnt work. If it did it would have saved her life.

[Anouka]

12. Would it have?

I keep thinking of Dr. Donda West doctor shopping until she found a doctor willing to do the plastic surgery on her which killed her.

The health insurance companies are sick, don't get me wrong -- but at what point do you say 'no'? Never? who's going to pay for all those 'nevers'?

Edwards is using the Sarkisyan case because the Sarkisyans contacted him; that's fine. He didn't just throw a dart (I hope). I'm a little suspect myself, though, because just before Natalie died the blogosphere was suddenly inundated with news about what a horrible case this was. I mean like mere days before she died. I don't think Edwards is the one who began politicizing Sarkisyan's case and death.

I'll need to find that thread at Daily Kos which raised the question about whether any of their health plans would have covered the Sarkisyan case, and if maybe this was the one time that Cigna may have been in the right.

[Egnever]

21. Well the docs she was seeing thought it was worth a try

If We had universal health care would they have tried? I dont know. I do know I dont ever want to be in a situation where my insurance dictates the care I recieve.

And just cause no other insurance company would have covered it either doesnt make it sit well with me.

[berni_mccoy]

29. WRONG. The Insurance company was definitely at fault. If you read the entire story of this tragedy

You would see that. The insurance company transferred this girl and her family from hospital to hospital for her Leukemia. It wasn't the doctors doing that. This happened no fewer than 4 times throughout her treatment. Liver failure was likely a result of inconsistent treatments from all this transferring. Furthermore, they hassled the family on other issues related to her care. And you are comparing PLASTIC SURGERY to a Leukemia patient. Those two things are worlds apart. Of course, plastic surgery for non-reconstructive reasons should be treated differently (not always, but there are good rules for this that doctors usually know when it is and isn't). The point is, the DOCTORS with their PATIENTS should be making these decisions, NOT the insurance companies.

[Cameron27]

7. I think there's a committee of doctors and other professionals

who ultimately decide who gets on the list. I don't know whether ability to pay is a consideration, but if it is, I'd guess that's where insurance companies come into the picture. I'll have to look it up.

[seriousstan]

10. I always let my mechanic decide what procedures need to take place.

:sarcasm:
I don't trust the doctors any more than I trust the insurance companies. Thank God for the internet. I have info.

If you abdicate authority to the doctors, I guess you don't know many doctors.

[Anouka]

14. Then they must make a lot of money off you.

I gave up on mechanics' trustworthiness when I went to Pep Boys to find out why my instrument panel died. The car ran, but I had no lights, no signals, no odometer (!) no nothing.

I told them what happened, and they wanted the $75 for the diagnostic... and $150 at the same time to remove my entire front dashboard panel on the inside to find out why the lights were out.

I'm thinking to myself, they must think I'm female. They're right, but I don't have time to be taken this blatantly advantage of.

I told them no. Do the diagnostic alone.

It was the computer chip. Replace the chip, and everything works fine, *without* removing the entire front dashboard (that I'm aware of).


I'm sure some folks here can give you stories about doctors who do unnecessary procedures. I know that for black women, doctors are known for suggesting unnecessary hysterectomies. That's a major surgery, physically and psychologically. So, why are so many black women told that it's necessary in comparison with non-black women who come to doctors with the same symptoms/conditions? Gotta be careful.

That's the flip side of opinion shopping. Sometimes, they dont have your best interests at heart after all.

As for this case, more information needs to be known about what Natalie's condition was, and the doctors who made the recommendation, and what else occurred around the time the recommendation was made before Cigna said 'no'.

[seriousstan]

17. I'm sorry. I guess I forgot this

:sarcasm:

[Anouka]

22. Thanks for adding the tag. n/t

[12string]

23. Doctors

 Just because your parents can afford to send you to medical
school doesn't mean you are good at what you do.Excellence in
any field of endeavor,be it
tradesman,waitress,lawyer,doctor,etc.,is the exception,not the
rule.

[berni_mccoy]

30. B.S. Doctors must maintain their licenses with regular testing.

They can not persist to be doctors unless they know what they are doing. Yes, there are bad doctors, but the occurrence is astronomically smaller than Insurance companies denying claims for profit or for making it purposely difficult for people to get coverage or have their bills paid as they agreed to do. And if you keep pushing that meme, you will contribute to the degradation of doctors in this country. Go ahead and label the ONLY people who can care for you when you are sick as the bad guys.

[Triana]

18. EXACTLY. And that is JUST the thing Edwards is fighting...to get the insurance..

...and drug companies OUT of this equation.

The doctor and ONLY the doctor should be making those decisions. NOT insurance companies!

[Vickers]

5. "Cigna Corp. rejected coverage for a liver transplant"

That should be your thread title...

[fenriswolf]

9. real good post and good evidance

Cigna defended its handling of the case. "I'm perplexed that this has become a campaign issue," said Jeffrey Kang, Cigna's chief medical officer. "It is highly unlikely that any health-care insurance system, nationally or internationally, would have covered this procedure."


well the insurance company that now has negative national attention is defending its position, well well how about that.

and as far as i am concerned about health insurance companies, all i have to say is this. If someone is willing to pay those huge fees if their life is in danger the insurance company should do everything it can to help the person. this article states that it had a slim chance of saving her life.

she was dying of leukimia when her liver failed, if she had a succesfull transplant (she had a good 65% chance not a slim chance) she would have another six months to battle the leukimia. i think it is in poor taste of you posting this article with the intention of making edwards look like he is using this poorfamily for his benifit (from what i understand the volunteered to speak for edwards campaign and were not asked to do this) or to try to paint a picture that this women was dying and even a new liver could not save her from certain death.

begone

[Cameron27]

13. We'd better get the facts straight first.

There's a long list of patients waiting for transplants and a 65% chance of recovery may not have been good enough. I'm not saying that it wasn't, but we really have to know what the criteria is before judging it's fairness.

[Born_A_Truman]

15. I believe the doctors appealed to Cigna

I think it was UCLA and if it was, my BIL had a liver transplant there three years before he died. They have a transplant team and the entire team must agree or there is no transplant.

From what I read of this case, the doctors wrote Cigna in the appeal process, so they must have agreed it was worth doing. My BIL was turned down by his transplant team later for a kidney my husband was going to donate because at that point the cardiologist on the team didn't agree to it and said his heart wouldn't make it through the surgery.

[madrchsod]

20. my best friends are going to face this fact in the next few months...

[Triana]

16. TWO things:

FIRST, John Edwards isn't "USING" that family. THEY ASKED HIM if they could join him on the campaign trail to tell their story so that this type of thing wouldn't happen to anyone else.

SECONDLY, IT SHOULD BE STRICTLY UP TO THE DOCTORS what treatment Nataline received. NO INSURANCE COMPANY should have had ANY say in it at all. INSURANCE COMPANIES HAVE NO BUSINESS DECIDING WHAT CARE PATIENTS OUGHT TO GET. That is the DOCTORS - and ONLY the doctor's job.

And THAT is the point of all this.

I don't care if Nataline had leukemia. If she was YOUR DAUGHTER - wouldn't you want her to have EVERY CHANCE available to survive? I'm sure you would. And you would NOT want an insurance company DECIDING FOR YOU and for her DOCTOR what treatment or procedure she should get in order to live.


JOHN EDWARDS GETS THAT.


Do you?


I CERTAINLY don't expect the WALL STREET JOURNAL to get it - and if they DID get it I'd expect them to DENY it and trash John Edwards.

We're talking about WALL STREET here. Puhleeeeeeze.

CONSIDER THE SOURCE of this story. THEN look at the slant and how it COMPLETELY IGNORES the issue at hand.

Pfffffffffffft!

I call utter smear and bullshit on this article particularly considering the source.

[madrchsod]

19. 65% chance for 6 more months

after a bone marrow transplant failed and she went into a coma. there is no right or wrong in this case...decisions on life or death are ones that many face and are all equally hard to do..no matter what the doctors say one way or the other, one has to decide what is best for their loved one...it was the hardest decision in my life but i will never regret it

[alcibiades_mystery]

24. Agreed

What if the next name down on the list had an 85% chance of complete recovery?

How would people respond then?

These are not easy or obvious choices. They are maddening and wrenching choices.

[Tesha]

26. But the choice wasn't made by the organ suppliers; it was made by the insurance company.

Surely you knew that, though.

Tesha

[alcibiades_mystery]

27. What's with the snark?

I don't care who made the choice. The choices are difficult as hell, no?

We simplify them into an easy narrative of villainy at considerable peril.

[madrchsod]

33. my friend will be put on a list..

each month he will have an exam to check on his condition. i`m not sure of all the criteria that the list involves but i do know it`s not set in stone. i personally know of one case where a person was on the list but she continually used drugs and drank and she was taken off the list. whether we like it or not,doctors have the responsibility in these cases to weigh all the factors involving whether a person lives or dies. insurance companies should`t be involved in their decisions

[Tennessee Gal]

25. This not about a medical case becoming political.

This about the fact that insurance companies should not have the right to decide what procedures they will pay for once doctors have deemed it a necessary procedure.

John Edwards is right on the mark with this. I think the fact that the family is supporting him and appearing in public for him confirms that.

[area51]

28. Well said. (n/t)

[bpeale]

31. THEY contacted Edwards not the other way around

he did not intrude on their grief to "use" them. they called him & asked to speak on his behalf.

[ljm2002]

32. Well, if it "boils down to a philosophical argument"...

...then I'd rather it was my doctor making the call, not some twerp insurance adjuster in another state whose ONLY motivation is to deny, deny, deny care of one sort or another.

Amazing how good we humans are at rationalizing the current state of affairs, whatever it may be. The fact is that our current medical system, when compared with those of other advanced nations, is downright criminal.