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1. A New Way To Ration Healthcare In The United States

   • Daniel G. arkfeld, md

   USC Keck School of Medicien

   It is a compelling argument that one would limit off- label uses of therapeutics based on a financial limit of $12,000 per year. As a rheumatologist I often have to decide on therapies for patients who have rare disorders. Whether it be a patient with catastrophic antiphospholipid syndrome, adult onset still's disease with hemophagocytosis, or amyloidosis secondary to familial mediterranean fever, there are often no available FDA approved therapeutics. Usually a cytokine directed therapy that is currently available for a different disorder is used in this context with much success. Such treatments would commonly exceed $12,000 a year. I am hoping that these decisions will not be based on financial llmitations but rather on risk/benefit analysis. This will lead to rationing of health care that will be biased against orphan and other disorders. It will elevate the FDA to the one's that will de facto be choosing whether patients will live or die.

   Conflict of Interest:

   None declared

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   Published March 5, 2009