Shannon Brownlee's newest piece at TIME Ideas calls the FDA's de-labeling of Avastin as a breast cancer treatment "one of the most important decisions ever made by a federal agency for the nation’s long-term fiscal outlook." We don't think that's an understatement.
The importance of the Avastin decision is twofold: it strengthens the institution, and it paves the way for making the hard-but-inevitable choices that will allow us to contain health care costs in the future.
As we've noted, the whole purpose of the FDA is to determine which drugs are safe and effective. Avastin used to treat breast cancer is neither for most patients, and until the manufacturer can show that there is a sub-population of patients that can benefit, women who take it are more likely to be harmed by the drug than helped.
Now, we need to go one step further, and acknowledge that when the FDA rejects a drug--not just when it has not approved it, but when it has actively rejected it--the fiscally and medically responsible choice is not to continue paying for the treatment. As Brownlee notes in the piece, it's not a small part of the cost problem:
"Avastin is just one example of the dozens, perhaps even hundreds of drugs, tests, surgeries and medical devices that offer marginal, if any benefit to patients, which we pay for nevertheless. To take just a single example, it’s estimated that about one-third of the imaging tests, the hundreds of millions of X rays, CT scans and MRIs that are performed each year, do little if anything to improve doctors’ ability to diagnose their patients’ conditions or change the course of treatment they recommend."