In talking about Opdivo, the new drug for people with advanced lung cancer that can add up to 2 years of life, Bach asserts:
"Federal law prevents the maker of nivolumab (Bristol-Myers Squibb) from providing assistance to patients who cannot afford the treatment. Programs such as Genentech's for Avastin, in which beneficiaries receive the drug free once they have spent a certain amount in a calendar year, are rare."
Untrue. Companies can't provide assistance directly but it can do so through 3rd party foundations and do so regularly. BMS provides an incredible amount of support to patients which frankly is provided because insurers don't cover the cost of the entire drug though it saves them money and improves patient lives better than stuff like surgery (which insurers cover completely). But in Bach's warped world, this is fine.
Then he proclaims that the only way to measure value is to see how much a new medicine or technology adds to a health plan's budget. Let's set aside the fact that most health care spending increases are the result of an increase in the use of other services and Bach never scrutinizes that. More important, new medicines almost always over time reduce the use of other services and contribute to at least half the increase productivity and longevity.
Bach claims that new medicines are no more effective than old medicines because they don't add any more average survival. Really? If that's the case than, how has cancer survivorship and life expectancy steadily increased over the past 20 years. Perhaps what he is say is that the additional increment of average survival (which ignores genomic variation) is not worth say $100000. But that ignores the fact that treatments are targeted to smaller populations that have fewer options than previous generations. Unfortunately, high prices are partially a result of investing the same amount of time and money on tinier groups of cancer patients. Bach knows better. After all, one of his co-authors in the paper he cites in his NEJM oral hallucination about new drugs not adding more survival despite higher prices, makes that very point in another study: " In the absence of significant pricing and total oncology outlay flexibility by payers, our analysis suggests that private sector investment in small oncology segments, and in stratified medicine generally, may not prove economically sustainable, thus endangering the translation of scientific advances into bedside medicines. Beyond increasing reimbursement, decreasing development cycle time and costs, or both, would most directly improve the economic incentives facing developers. By contrast, extending exclusivity periods, or initiating advance market commitments and awarding prizes would likely have less impact and involve greater implementation challenges." (Trusheim, Berndt "Economics of Stratified Medicine" Personalized Medicine (2012) 9(4), 413–427)
So in otherwords, Bach wants lower prices at all costs, even if it kills innovation and people.
Bach is channelling Andrew Wakefield, another lighly published doctor who used the media to advance an agenda that proved toxic to the public health.